Provider Demographics
NPI:1245741511
Name:INTERCOUNTY COUNCIL ON DRUG AND ALCOHOL ABUSE, INC.
Entity Type:Organization
Organization Name:INTERCOUNTY COUNCIL ON DRUG AND ALCOHOL ABUSE, INC.
Other - Org Name:ICCDAA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCADC,CCS, CPAS
Authorized Official - Phone:201-998-7422
Mailing Address - Street 1:480 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2736
Mailing Address - Country:US
Mailing Address - Phone:201-998-7422
Mailing Address - Fax:201-998-1136
Practice Address - Street 1:480 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2736
Practice Address - Country:US
Practice Address - Phone:201-998-7422
Practice Address - Fax:201-998-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility