Provider Demographics
NPI:1205155637
Name:DAVID AICHROTH LCADC, LSW,
Entity type:Organization
Organization Name:DAVID AICHROTH LCADC, LSW,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL ALCHOL AND DRUG C
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:AICHROTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCADC
Authorized Official - Phone:631-219-9503
Mailing Address - Street 1:11 DUNDAR RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3513
Mailing Address - Country:US
Mailing Address - Phone:631-219-9503
Mailing Address - Fax:908-822-0449
Practice Address - Street 1:11 DUNDAR RD STE 105
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3513
Practice Address - Country:US
Practice Address - Phone:631-219-9503
Practice Address - Fax:908-822-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05429400104100000X
NJ3LC00163100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty