Provider Demographics
NPI:1801429246
Name:AICHROTH, DAVID JR (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:AICHROTH
Suffix:JR
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:ANDRE
Other - Last Name:AICHROTH
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:DAVID AICHROTH
Mailing Address - Street 2:11 DUNDAR RD SUITE 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2210
Mailing Address - Country:US
Mailing Address - Phone:631-356-3884
Mailing Address - Fax:973-926-9526
Practice Address - Street 1:DAVID AICHROTH
Practice Address - Street 2:11 DUNDAR RD SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2210
Practice Address - Country:US
Practice Address - Phone:631-356-3884
Practice Address - Fax:973-926-9526
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL054294001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical