Provider Demographics
NPI:1669631370
Name:DEBLASIO, DOMINICK ANTHONY (LPC LCADC)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:ANTHONY
Last Name:DEBLASIO
Suffix:
Gender:M
Credentials:LPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1311
Mailing Address - Country:US
Mailing Address - Phone:732-773-5431
Mailing Address - Fax:
Practice Address - Street 1:201 LINCOLN AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2909
Practice Address - Country:US
Practice Address - Phone:908-276-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00101900101YA0400X
NJ37PC00119700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)