Provider Demographics
NPI:1164032652
Name:TACTUK, JARED (LCSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:TACTUK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MAIN AVE STE 278
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1748
Mailing Address - Country:US
Mailing Address - Phone:973-692-5127
Mailing Address - Fax:973-807-1992
Practice Address - Street 1:95 MAIN AVE STE 278
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1748
Practice Address - Country:US
Practice Address - Phone:973-692-5127
Practice Address - Fax:973-807-1992
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058829001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical