Provider Demographics
NPI:1366868960
Name:MCLOUGHLIN, JACKIE
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:Y
Other - Last Name:MCLOUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:136 BROADWAY
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8078
Mailing Address - Country:US
Mailing Address - Phone:201-391-4492
Mailing Address - Fax:201-391-1504
Practice Address - Street 1:136 BROADWAY
Practice Address - Street 2:SUITE # 2
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8078
Practice Address - Country:US
Practice Address - Phone:201-391-4492
Practice Address - Fax:201-391-1504
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051804001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical