Provider Demographics
NPI:1336450147
Name:MAGEE-GARY, ERIN (LCADC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MAGEE-GARY
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1087
Mailing Address - Country:US
Mailing Address - Phone:201-873-6361
Mailing Address - Fax:973-241-4136
Practice Address - Street 1:290 UNION BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2610
Practice Address - Country:US
Practice Address - Phone:201-873-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00117200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)