Individual provider Active NPI

Jo Myman, LCADC

  • Addiction (Substance Use Disorder) Counselor
  • Eatontown, NJ
National Provider Identifier
1629631627
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
37LC00286700 Issued in NJ
Practice address
3 Corbett Way
Eatontown, NJ 07724-2283
Phone
(732) 210-0509
Fax
(732) 542-1948
NPI assigned
Apr 16, 2019
Last updated
Apr 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 37LC00286700 NJ Primary

Addresses

Primary practice location

3 Corbett Way
Eatontown, NJ 07724-2283

Mailing address

3 Corbett Way
Eatontown, NJ 07724-2283
Phone (732) 210-0509

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

LicenseStateTypeSpecialty
37LC00286700NJMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1629631627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242283",
            "telephone_number": "732-210-0509",
            "fax_number": "732-542-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242283",
            "telephone_number": "732-210-0509",
            "fax_number": "732-542-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYMAN",
        "first_name": "JO",
        "credential": "LCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-16",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00286700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.