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General NPI Number Information
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NPI Number | 1417711367
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Entity Type | Individual
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Provider Name | JERMAINE HIBBERT LAC
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 935 ALLWOOD RD STE 300
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City | CLIFTON
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State | NJ
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Zip | 07012-1988
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Country | US
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Telephone | 862-930-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 25 DODD ST
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City | NUTLEY
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State | NJ
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Zip | 07110-1715
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Country | US
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Telephone | 917-244-0885
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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