Provider Demographics
NPI:1952747867
Name:LAGGNER, JOHN A (LCADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:LAGGNER
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2304
Mailing Address - Country:US
Mailing Address - Phone:848-448-5515
Mailing Address - Fax:970-514-7157
Practice Address - Street 1:328 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2304
Practice Address - Country:US
Practice Address - Phone:848-448-5515
Practice Address - Fax:970-514-7157
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00190900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)