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General NPI Number Information
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NPI Number | 1104132026
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Entity Type | Organization
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Legal Business Name | RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 100 DAVIDSON AVE STE 203
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City | SOMERSET
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State | NJ
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Zip | 08873-1312
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Country | US
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Telephone | 732-213-1311
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Fax | 732-613-9192
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Provider Business Mailing Address
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Address Line | 100 DAVIDSON AVE, SUITE 203
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-213-1311
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Fax | 732-613-9192
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. THOMAS ETTS
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Credential | LCSW, LCADC
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Telephone | 732-213-1311
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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 | 37LC00101000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05321300
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License Number State | NJ
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