Provider Demographics
NPI:1639669153
Name:JODEXNIS, DANIEL A JR (LCADC, LAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:JODEXNIS
Suffix:JR
Gender:M
Credentials:LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 EAST AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2662
Mailing Address - Country:US
Mailing Address - Phone:908-441-1554
Mailing Address - Fax:
Practice Address - Street 1:112 EAST AVE STE 9
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-441-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00268600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)