Provider Demographics
NPI:1942221361
Name:THOMAS-REA, BETH (LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:THOMAS-REA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:17 S FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2552
Mailing Address - Country:US
Mailing Address - Phone:201-753-1354
Mailing Address - Fax:201-848-0061
Practice Address - Street 1:17 S FRANKLIN TPKE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2552
Practice Address - Country:US
Practice Address - Phone:201-753-1354
Practice Address - Fax:201-848-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00092400101YA0400X
NJ44SC052568001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ743961Medicare PIN