Provider Demographics
NPI:1396282802
Name:SABO, JACLYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:SABO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MONTAGUE PL
Mailing Address - Street 2:APARTMENT 9
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2837
Mailing Address - Country:US
Mailing Address - Phone:732-221-7514
Mailing Address - Fax:
Practice Address - Street 1:80 POMPTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2945
Practice Address - Country:US
Practice Address - Phone:973-944-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPERMIT #153-121103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool