Provider Demographics
NPI:1033609151
Name:MOORE, IRENA (LPC, LCADC)
Entity Type:Individual
Prefix:MS
First Name:IRENA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PETUNIA DR APT 1G
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3617
Mailing Address - Country:US
Mailing Address - Phone:973-600-4975
Mailing Address - Fax:
Practice Address - Street 1:660 TENNENT RD STE 104
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3163
Practice Address - Country:US
Practice Address - Phone:732-851-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00580400101YP2500X
NJ37LC00280400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)