Provider Demographics
NPI:1871137257
Name:AYDIN, JACKLIN
Entity type:Individual
Prefix:
First Name:JACKLIN
Middle Name:
Last Name:AYDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKLIN
Other - Middle Name:
Other - Last Name:KURTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:312 AMBOY AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 CARNATION DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2507
Practice Address - Country:US
Practice Address - Phone:201-644-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00594100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional