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General NPI Number Information
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NPI Number | 1043633845
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Entity Type | Individual
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Provider Name | JOSEPH DAVID RETIK LPC, CCH
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 470 COLFAX AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1624
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Country | US
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Telephone | 973-473-2343
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Fax | 973-473-2308
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Provider Business Mailing Address
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Address Line | 644 GRANT AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-1533
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00488800
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License Number State | NJ
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