Healthcare Provider Details

I. General information

NPI: 1962327007
Provider Name (Legal Business Name): JAROLD RAIM PRADEL LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 MORRIS AVE STE 308
UNION NJ
07083-5914
US

IV. Provider business mailing address

31 MOUNTAIN BLVD BLDG U
WARREN NJ
07059-5648
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-9623
  • Fax:
Mailing address:
  • Phone: 908-322-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00960000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: