Provider Demographics
NPI:1760115810
Name:GUNNING, LYNDON STAFFORD (BA CADC)
Entity Type:Individual
Prefix:MR
First Name:LYNDON
Middle Name:STAFFORD
Last Name:GUNNING
Suffix:
Gender:M
Credentials:BA CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WALNUT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1647
Mailing Address - Country:US
Mailing Address - Phone:732-882-1920
Mailing Address - Fax:
Practice Address - Street 1:60 WALNUT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1647
Practice Address - Country:US
Practice Address - Phone:732-882-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00124300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)