Provider Demographics
NPI:1457032369
Name:NAZAIRE, ROGES (LCADC)
Entity Type:Individual
Prefix:MR
First Name:ROGES
Middle Name:
Last Name:NAZAIRE
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:MR
Other - First Name:ROGES
Other - Middle Name:
Other - Last Name:NAZAIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:515 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-7125
Mailing Address - Country:US
Mailing Address - Phone:732-912-9229
Mailing Address - Fax:
Practice Address - Street 1:47 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1011
Practice Address - Country:US
Practice Address - Phone:609-396-8787
Practice Address - Fax:609-396-6280
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00366100101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health