Provider Demographics
NPI:1376020057
Name:SCALES, JACKLYN S (LCS)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:S
Last Name:SCALES
Suffix:
Gender:F
Credentials:LCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:732-643-2070
Mailing Address - Fax:732-643-2015
Practice Address - Street 1:3000 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-2400
Practice Address - Country:US
Practice Address - Phone:732-643-2070
Practice Address - Fax:732-643-2015
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055218001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical