Provider Demographics
NPI:1578318580
Name:SARGENT, LARRY JOSEPH II (CADC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JOSEPH
Last Name:SARGENT
Suffix:II
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STULTS RD STE 137
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1549
Mailing Address - Country:US
Mailing Address - Phone:732-908-2221
Mailing Address - Fax:
Practice Address - Street 1:12 STULTS RD STE 137
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1549
Practice Address - Country:US
Practice Address - Phone:732-908-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00147700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)