Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00050700 | NJ |
N | 101YP2500X | Professional Counselor | 37PC00075900 | NJ |
NPI | 1003977588 |
---|---|
Provider Name | Colleen Mcgrathbaird |
First Address | Rockaway, NJ 07866-1631 |
Second Address | Newfoundland, NJ 07435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 09/07/2007 |