Healthcare Provider Details

I. General information

NPI: 1003935610
Provider Name (Legal Business Name): THE LENNARD CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 FRELINGHUYSEN AVE
NEWARK NJ
07114-1426
US

IV. Provider business mailing address

461 FRELINGHUYSEN AVE
NEWARK NJ
07114-1426
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-2850
  • Fax: 973-596-8180
Mailing address:
  • Phone: 973-596-2850
  • Fax: 973-596-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MRS. CHALYNDA MAYNARD
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 973-704-1557