Basic Information
Provider Information | |||||||||
NPI: | 1417406240 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRICK | ||||||||
FirstName: | JOSHUA | ||||||||
MiddleName: | J. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.C.S.W., L.C.A.D.C. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 49 NEW RD | ||||||||
Address2: |   | ||||||||
City: | KENDALL PARK | ||||||||
State: | NJ | ||||||||
PostalCode: | 088241160 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3229055507 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4326 US 1 | ||||||||
Address2: |   | ||||||||
City: | MONMOUTH JUNCTION | ||||||||
State: | NJ | ||||||||
PostalCode: | 08852 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7322355000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/21/2016 | ||||||||
LastUpdateDate: | 10/20/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/20/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 37LC00246600 | NJ | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 44SC05921600 | NJ | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.