Active NPI
Ethan Moutner
- Social Worker
- Manalapan, NJ
National Provider Identifier
1497571483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 44SL06389000
- Practice address
- 100 Craig Rd Ste 220
Manalapan, NJ 07726-8731 - Phone
- (732) 913-0033
- NPI assigned
- Nov 25, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL06389000 | NJ | Primary |
Addresses
Primary practice location
100 Craig Rd Ste 220
Manalapan, NJ 07726-8731
Mailing address
22 Hemlock Dr
Jamesburg, NJ 08831-2529
Phone (732) 580-6578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL06389000 | NJ | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenium Therapy and Wellness | Current | Accepting new patients | |
| Premier Mental & Behavioral Services, Inc | Current | Accepting new patients |
Locations
100 Craig Rd
Ste 220
Manalapan, NJ 07726
Phone (732) 693-3916
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Manalapan, NJ
- NPI 1326818071
-
- Psychiatric/Mental Health Nurse Practitioner
- Manalapan, NJ
- NPI 1346139482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732492800000",
"number": "1497571483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 HEMLOCK DR",
"city": "JAMESBURG",
"state": "NJ",
"postal_code": "088312529",
"telephone_number": "732-580-6578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CRAIG RD STE 220",
"city": "MANALAPAN",
"state": "NJ",
"postal_code": "077268731",
"telephone_number": "732-913-0033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUTNER",
"first_name": "ETHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-25",
"last_updated": "2024-11-25",
"certification_date": "2024-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SL06389000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manalapan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.