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General NPI Number Information
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NPI Number | 1023196367
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Entity Type | Individual
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Provider Name | MOSES MYERS JR. MS, LCADC,SAP
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 2130 MILLBURN AVE SUITE D1
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3725
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Country | US
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Telephone | 908-875-5123
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Fax | 973-763-8243
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Provider Business Mailing Address
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Address Line | 612 THOMPSON AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-2209
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Country | US
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Telephone | 908-875-5123
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Fax | 973-763-8243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00083500
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License Number State | NJ
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