Healthcare Provider Details

I. General information

NPI: 1780811620
Provider Name (Legal Business Name): JOHN LARE NCC, LPC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 DOLPHIN AVE
NORTHFIELD NJ
08225-2599
US

IV. Provider business mailing address

1105 DOLPHIN AVE
NORTHFIELD NJ
08225-2599
US

V. Phone/Fax

Practice location:
  • Phone: 310-909-3750
  • Fax:
Mailing address:
  • Phone: 310-909-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00422700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01264200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: