Provider Demographics
NPI:1073982278
Name:ADDICTION COUNSELING VINCENT G DENOTARIS MA LCADC SAC
Entity Type:Organization
Organization Name:ADDICTION COUNSELING VINCENT G DENOTARIS MA LCADC SAC
Other - Org Name:ADDICTION COUNSELING VINCENT G DENOTARIS MA LCADC SAC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED DRUG AND ALCOHOL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:DENOTARIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:973-534-9276
Mailing Address - Street 1:25 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2941
Mailing Address - Country:US
Mailing Address - Phone:973-534-9276
Mailing Address - Fax:
Practice Address - Street 1:25 POMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044
Practice Address - Country:US
Practice Address - Phone:973-534-9276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00190000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health