Provider Demographics
NPI:1043896434
Name:MCENTYRE, ANDRE L (LCADC, MSW)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:L
Last Name:MCENTYRE
Suffix:
Gender:M
Credentials:LCADC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22-08 ROUTE 208 STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2609
Mailing Address - Country:US
Mailing Address - Phone:800-741-3300
Mailing Address - Fax:
Practice Address - Street 1:78 LAFAYETTE ST APT 3
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1149
Practice Address - Country:US
Practice Address - Phone:973-876-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00290900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)