Provider Demographics
NPI:1649585654
Name:NEGRON, ROBERTO (LCADC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:NEGRON
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 1:5301 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2622
Mailing Address - Country:US
Mailing Address - Phone:201-866-9320
Mailing Address - Fax:201-330-3825
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-330-3825
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC000647000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)