Provider Demographics
NPI:1053866590
Name:REGISTER, EMMANUEL V (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:V
Last Name:REGISTER
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-0736
Mailing Address - Country:US
Mailing Address - Phone:201-858-1119
Mailing Address - Fax:
Practice Address - Street 1:893 BROADWAY STE 736
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3053
Practice Address - Country:US
Practice Address - Phone:201-858-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2022-12-01
Deactivation Date:2017-10-28
Deactivation Code:
Reactivation Date:2022-11-29
Provider Licenses
StateLicense IDTaxonomies
NJ44SL0588650104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker