Healthcare Provider Details

I. General information

NPI: 1689213548
Provider Name (Legal Business Name): DANA LACLAIR BS, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 KNIGHTSBRIDGE RD STE 625-626
PISCATAWAY NJ
08854-3925
US

IV. Provider business mailing address

671 HOES LANE
PISCATAWAY NJ
08854
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00159200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: