Healthcare Provider Details

I. General information

NPI: 1184348278
Provider Name (Legal Business Name): JOHN PELIKAN MSW, LCSW, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD STE 405
LINWOOD NJ
08221-1283
US

IV. Provider business mailing address

222 NEW RD STE 405
LINWOOD NJ
08221-1283
US

V. Phone/Fax

Practice location:
  • Phone: 609-798-1453
  • Fax:
Mailing address:
  • Phone: 609-798-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00355100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC06239500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06239500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: