Provider Demographics
NPI:1194381350
Name:MAGGIO, JOHN JR (MA, LCADC, LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MAGGIO
Suffix:JR
Gender:M
Credentials:MA, LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 LAUREL BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1746
Mailing Address - Country:US
Mailing Address - Phone:551-497-1964
Mailing Address - Fax:
Practice Address - Street 1:415 LAUREL BROOK RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1746
Practice Address - Country:US
Practice Address - Phone:551-497-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00281400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)