Provider Demographics
NPI:1063818193
Name:CILENTE, JERALD (PHD, LCADC, ABMPP)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:
Last Name:CILENTE
Suffix:
Gender:M
Credentials:PHD, LCADC, ABMPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076
Mailing Address - Country:US
Mailing Address - Phone:908-322-9180
Mailing Address - Fax:908-322-9094
Practice Address - Street 1:1830 FRONT STREET
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076
Practice Address - Country:US
Practice Address - Phone:908-322-9180
Practice Address - Fax:908-322-9094
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00185000101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00185000Medicaid