Provider Demographics
NPI:1447913074
Name:JERMIN, TONY (CADC)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:JERMIN
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N FULTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-7506
Mailing Address - Country:US
Mailing Address - Phone:347-981-2938
Mailing Address - Fax:
Practice Address - Street 1:40 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SEWAREN
Practice Address - State:NJ
Practice Address - Zip Code:07077-1351
Practice Address - Country:US
Practice Address - Phone:732-636-1931
Practice Address - Fax:732-636-1943
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37CA00135100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)