Provider Demographics
NPI:1023196367
Name:MYERS, MOSES JR (MS, LCADC,SAP)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:MS, LCADC,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2209
Mailing Address - Country:US
Mailing Address - Phone:908-875-5123
Mailing Address - Fax:973-763-8243
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:SUITE D1
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:908-875-5123
Practice Address - Fax:973-763-8243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00083500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)