=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396586293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARMETERICK JOSEPH MOORE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2509 PARK AVE STE 2B
-----------------------------------------------------
City | SOUTH PLAINFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07080-5369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-434-7830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2804 VILLAGE DR
-----------------------------------------------------
City | AVENEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07001-1077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00601800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------