Provider Demographics
NPI:1619492493
Name:GOPIN, AVI I (LPC)
Entity Type:Individual
Prefix:MR
First Name:AVI
Middle Name:I
Last Name:GOPIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 LAKEHURST RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7340
Mailing Address - Country:US
Mailing Address - Phone:732-930-2242
Mailing Address - Fax:732-569-6819
Practice Address - Street 1:388 LAKEHURST RD STE 2A
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7340
Practice Address - Country:US
Practice Address - Phone:732-930-2242
Practice Address - Fax:732-930-2242
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00379000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1619421625OtherEMPLOYER TYPE II NPI
NJ1619421625OtherTYPE II NPI