Provider Demographics
NPI:1154799815
Name:DENOTARIS, VINCENT G (LCADC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:G
Last Name:DENOTARIS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:ADDICTION COUNSELING
Other - Middle Name:VINCENT
Other - Last Name:DENOTARIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:25 POMPTON AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2941
Mailing Address - Country:US
Mailing Address - Phone:973-534-9276
Mailing Address - Fax:
Practice Address - Street 1:25 POMPTON AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2941
Practice Address - Country:US
Practice Address - Phone:973-534-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00190000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)