Provider Demographics
NPI:1760729545
Name:LABOLLITA, DEAN J (MSM, LCADC, CSW, CCS)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:J
Last Name:LABOLLITA
Suffix:
Gender:M
Credentials:MSM, LCADC, CSW, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 HOOPER AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2892
Mailing Address - Country:US
Mailing Address - Phone:732-814-1330
Mailing Address - Fax:732-358-0829
Practice Address - Street 1:1466 HOOPER AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2892
Practice Address - Country:US
Practice Address - Phone:732-814-1330
Practice Address - Fax:732-358-0829
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW047399001041C0700X
NJ37LC00077700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical