Healthcare Provider Details

I. General information

NPI: 1205155637
Provider Name (Legal Business Name): DAVID AICHROTH LCADC, LSW,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 DUNDAR RD STE 105
SPRINGFIELD NJ
07081-3513
US

IV. Provider business mailing address

11 DUNDAR RD STE 105
SPRINGFIELD NJ
07081-3513
US

V. Phone/Fax

Practice location:
  • Phone: 631-219-9503
  • Fax: 908-822-0449
Mailing address:
  • Phone: 631-219-9503
  • Fax: 908-822-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3LC00163100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05429400
License Number StateNJ

VIII. Authorized Official

Name: MR. DAVID ANDRE AICHROTH JR.
Title or Position: LICENSED CLINICAL ALCHOL AND DRUG C
Credential: LCADC
Phone: 631-219-9503