Provider Demographics
NPI:1558946913
Name:ROONEY, KYLE (LCADC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ROONEY
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 1:346 HEATHER DR N
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1817
Mailing Address - Country:US
Mailing Address - Phone:856-318-6082
Mailing Address - Fax:
Practice Address - Street 1:707 WHITE HORSE RD STE C101
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:856-805-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00326600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)