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General NPI Number Information
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NPI Number | 1184082539
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Entity Type | Individual
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Provider Name | VLADIMIR CHRISTOPHE LCSW, LCADC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2016
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1140 BURNT TAVERN RD SUITE 2C
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City | BRICK
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State | NJ
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Zip | 08724-1496
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Country | US
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Telephone | 201-746-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 BURNT TAVERN RD SUITE 2C
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City | BRICK
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State | NJ
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Zip | 08724-1496
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00231100
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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 | CW019763
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05631600
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License Number State | NJ
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