Provider Demographics
NPI:1609548387
Name:SMERKLO, THERESE L (LPC, LCADC)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:L
Last Name:SMERKLO
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2812
Mailing Address - Country:US
Mailing Address - Phone:973-222-7211
Mailing Address - Fax:
Practice Address - Street 1:92 BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2733
Practice Address - Country:US
Practice Address - Phone:973-222-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00585500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty