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General NPI Number Information
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NPI Number | 1205155637
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Entity Type | Organization
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Legal Business Name | DAVID AICHROTH LCADC, LSW,
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 11 DUNDAR RD STE 105
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3513
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Country | US
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Telephone | 631-219-9503
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Fax | 908-822-0449
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Provider Business Mailing Address
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Address Line | 11 DUNDAR RD STE 105
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3513
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Country | US
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Telephone | 631-219-9503
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Fax | 908-822-0449
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Authorized Official
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Title or Position | LICENSED CLINICAL ALCHOL AND DRUG C
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Name | MR. DAVID ANDRE AICHROTH JR.
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Credential | LCADC
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Telephone | 631-219-9503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05429400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3LC00163100
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License Number State | NJ
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