Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37L00233200 | NJ |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00233200 | NJ |
N | 101YM0800X | Mental Health Counselor | 37PC00590800 | NJ |
N | 101YM0800X | Mental Health Counselor | 37PC00590800 | PA |
N | 101YP2500X | Professional Counselor | PC008591 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 37LC00233200 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 37PC00590800 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 37PC00590800 | NJ |
N | 103TF0000X | Family Psychologist | 37PC00590800 | NJ |
NPI | 1619337482 |
---|---|
Provider Name | John Gore |
First Address | South Plainfield, NJ 07080-5369 |
Second Address | South Plainfield, NJ 07080-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2016 |
Last Update Date | 18/10/2019 |