Provider Demographics
NPI:1477087633
Name:BROOMES, MS, MARCELLUS E (LAC, LCADC)
Entity Type:Individual
Prefix:
First Name:MARCELLUS
Middle Name:E
Last Name:BROOMES, MS
Suffix:
Gender:M
Credentials:LAC, LCADC
Other - Prefix:MR
Other - First Name:MARCELLUS
Other - Middle Name:
Other - Last Name:BROOMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, LCADC
Mailing Address - Street 1:492 ROUTE 57 WEST
Mailing Address - Street 2:FAMILY GUIDANCE CENTER OF WARREN COUNTY
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4411
Mailing Address - Country:US
Mailing Address - Phone:908-689-1000
Mailing Address - Fax:908-689-4529
Practice Address - Street 1:370 MEMORIAL PARKWAY
Practice Address - Street 2:FAMILY GUIDANCE CENTER OF WARREN COUNTY
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1580
Practice Address - Country:US
Practice Address - Phone:908-454-4470
Practice Address - Fax:908-454-5317
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00232200101Y00000X
NJ37LC00206800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor