Healthcare Provider Details

I. General information

NPI: 1518384288
Provider Name (Legal Business Name): ASSAF AMOS LCSW, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MONROE ST
HOBOKEN NJ
07030-6503
US

IV. Provider business mailing address

61 MONROE ST
HOBOKEN NJ
07030-6503
US

V. Phone/Fax

Practice location:
  • Phone: 201-792-8290
  • Fax:
Mailing address:
  • Phone: 201-792-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05730200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00222400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: