Provider Demographics
NPI:1104468222
Name:OCHOA, JOHANN (MS, LCADC, LAC)
Entity type:Individual
Prefix:MR
First Name:JOHANN
Middle Name:
Last Name:OCHOA
Suffix:
Gender:M
Credentials:MS, LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BUTTS AVE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2214
Mailing Address - Country:US
Mailing Address - Phone:609-462-6728
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00464100101YM0800X
NJ37LC00298500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty