Provider Demographics
NPI:1104132026
Name:RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC
Entity type:Organization
Organization Name:RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:732-213-1311
Mailing Address - Street 1:100 DAVIDSON AVE, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-213-1311
Mailing Address - Fax:732-613-9192
Practice Address - Street 1:100 DAVIDSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1312
Practice Address - Country:US
Practice Address - Phone:732-213-1311
Practice Address - Fax:732-613-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00101000101YA0400X
NJ44SC053213001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty