Provider Demographics
NPI:1285753962
Name:TRUEX, BERT ROGER (LCADC)
Entity type:Individual
Prefix:MR
First Name:BERT
Middle Name:ROGER
Last Name:TRUEX
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2460
Mailing Address - Country:US
Mailing Address - Phone:908-241-8575
Mailing Address - Fax:
Practice Address - Street 1:117 ROOSEVELT AVE # 119
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1331
Practice Address - Country:US
Practice Address - Phone:908-756-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00060900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)