Individual
MARK A BACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LCADC
Contact information
Practice address
4 GOLD MINE RD, ROXBURY TOWNSHIP, NJ 07836-9122
(973) 527-7072
Mailing address
34 LEWISBURG RD, LAFAYETTE, NJ 07848-3145
(973) 224-4888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00204100
NJ
101YP2500X
Professional Counselor
Primary
37PC00564400
NJ
Other
Enumeration date
09/22/2018
Last updated
09/22/2018
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