Provider Demographics
NPI:1831305598
Name:INTER COUNTY COUNCIL ON DRUG AND ALCOHOL ABUSE
Entity Type:Organization
Organization Name:INTER COUNTY COUNCIL ON DRUG AND ALCOHOL ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-998-7422
Mailing Address - Street 1:480 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2736
Mailing Address - Country:US
Mailing Address - Phone:201-998-7422
Mailing Address - Fax:201-998-1136
Practice Address - Street 1:480 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2736
Practice Address - Country:US
Practice Address - Phone:201-998-7422
Practice Address - Fax:201-998-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40941261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100501-01Medicaid