Provider Demographics
NPI:1043498736
Name:REDMOND, AJA (LCADC)
Entity type:Individual
Prefix:MS
First Name:AJA
Middle Name:
Last Name:REDMOND
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:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-0702
Mailing Address - Country:US
Mailing Address - Phone:856-571-7122
Mailing Address - Fax:
Practice Address - Street 1:777 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1242
Practice Address - Country:US
Practice Address - Phone:973-594-0125
Practice Address - Fax:973-594-0536
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2024-08-07
Deactivation Date:2022-01-24
Deactivation Code:
Reactivation Date:2022-08-25
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00322100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)