=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093803587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN THOMAS HEMMERT LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 485 ROUTE 1 S BLDG C SUITE 130
-----------------------------------------------------
City | ISELIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-634-2811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 COUNTY ROAD 517
-----------------------------------------------------
City | CALIFON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07830-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-229-9570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00298400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------