Healthcare Provider Details

I. General information

NPI: 1467966549
Provider Name (Legal Business Name): LARRY RIMBERT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 S ORANGE AVE
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

671 HOES LN W
PISCATAWAY NJ
08854-8021
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5479
  • Fax: 973-972-3711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05666900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00181000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: