1760729545 NPI number — MR. DEAN J LABOLLITA MSM, LCADC, CSW, CCS

Table of content: MR. DEAN J LABOLLITA MSM, LCADC, CSW, CCS (NPI 1760729545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760729545 NPI number — MR. DEAN J LABOLLITA MSM, LCADC, CSW, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABOLLITA
Provider First Name:
DEAN
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSM, LCADC, CSW, CCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760729545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1466 HOOPER AVE
Provider Second Line Business Mailing Address:
SUITE 1C
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-2892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-814-1330
Provider Business Mailing Address Fax Number:
732-358-0829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1466 HOOPER AVE
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-2892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-814-1330
Provider Business Practice Location Address Fax Number:
732-358-0829
Provider Enumeration Date:
01/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SW04739900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 37LC00077700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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