Healthcare Provider Details

I. General information

NPI: 1629622683
Provider Name (Legal Business Name): BERNARD HOPKINS CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NEW YORK AVE
TRENTON NJ
08638-3913
US

IV. Provider business mailing address

2701 RENAISSANCE BLVD FL 4
KING OF PRUSSIA PA
19406-2781
US

V. Phone/Fax

Practice location:
  • Phone: 609-393-8000
  • Fax: 609-393-8020
Mailing address:
  • Phone: 484-333-3085
  • Fax: 484-393-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00061800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: