Provider Demographics
NPI:1720434947
Name:FAIRMAN, TERBETT (LCADC)
Entity Type:Individual
Prefix:MRS
First Name:TERBETT
Middle Name:
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 JAMIE CT
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2619
Mailing Address - Country:US
Mailing Address - Phone:609-955-6111
Mailing Address - Fax:
Practice Address - Street 1:4451 ROUTE 27
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-8708
Practice Address - Country:US
Practice Address - Phone:732-718-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00156300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)