Provider Demographics
NPI:1346468824
Name:CUMBERLAND COUNTY ALCOHOL AND DRUG ABUSE SERVICES
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY ALCOHOL AND DRUG ABUSE SERVICES
Other - Org Name:FIRST STEP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, MSC, LCADC
Authorized Official - Phone:856-451-3727
Mailing Address - Street 1:72 NORTH PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-451-3727
Mailing Address - Fax:856-455-9706
Practice Address - Street 1:72 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1943
Practice Address - Country:US
Practice Address - Phone:856-451-3727
Practice Address - Fax:856-455-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23030261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ23030OtherFACILITY LICENSE #