=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952792483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHALIN J BHATT LPC, LCADC, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2015
-----------------------------------------------------
Last Update Date | 03/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 DR MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-596-3414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 RIVER ROAD, SUITE 32 #156
-----------------------------------------------------
City | EDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07020-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-325-4715
-----------------------------------------------------
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 | 37LC00301400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00661000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------