Healthcare Provider Details

I. General information

NPI: 1396868071
Provider Name (Legal Business Name): CLIFFORD M KOBLIN LPC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 ROUTE 27
KINGSTON NJ
08528-9601
US

IV. Provider business mailing address

130 SPRING HILL RD
SKILLMAN NJ
08558-1418
US

V. Phone/Fax

Practice location:
  • Phone: 609-252-1152
  • Fax:
Mailing address:
  • Phone: 609-333-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00090100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC000336400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: