Individual provider · Type 1 NPI

Lijo Chacko

Mental Health Counselor · Port Jefferson Station, NY

NPI number 1033065255 Active

Practice location

650 Hallock Ave
Port Jefferson Station, NY 11776-1256

Mailing address

2954 Lawrence Dr
Wantagh, NY 11793-1049

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1033065255

Lijo Chacko's National Provider Identifier is 1033065255, issued on Mar 9, 2026. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Port Jefferson Station, NY. The record was last updated on Mar 9, 2026.