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General NPI Number Information
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NPI Number | 1649585654
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Entity Type | Individual
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Provider Name | ROBERTO NEGRON LCADC
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Gender | Male
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 5301 BROADWAY 2ND FLOOR
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2622
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Country | US
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Telephone | 201-866-9320
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Fax | 201-330-3825
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Provider Business Mailing Address
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Address Line | 5301 BROADWAY 2ND FLOOR
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2622
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Country | US
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Telephone | 201-866-9320
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Fax | 201-330-3825
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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 | 37LC000647000
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License Number State | NJ
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