Provider Demographics
NPI:1295191005
Name:GERNER, JASON (LCADC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GERNER
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 ILENE LN
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1229
Mailing Address - Country:US
Mailing Address - Phone:856-669-4988
Mailing Address - Fax:
Practice Address - Street 1:90 W AFTON AVE
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1421
Practice Address - Country:US
Practice Address - Phone:877-636-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37-LC00217300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)