Provider Demographics
NPI:1114052875
Name:GASPICH, JON JAMES (LCADC,CSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:JAMES
Last Name:GASPICH
Suffix:
Gender:M
Credentials:LCADC,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-9615
Mailing Address - Country:US
Mailing Address - Phone:609-294-2790
Mailing Address - Fax:
Practice Address - Street 1:16 JOHN ST
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08087-9615
Practice Address - Country:US
Practice Address - Phone:609-294-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00102100101YA0400X
NJ44SW00545100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SW00545100OtherCERTIFED SOCIAL WORKER
NJ37LC00102100OtherLACDC