Individual
MR. GEORGES HENRY MOMBRUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LCADC
Contact information
Practice address
560 MORRIS ST, ORANGE, NJ 07050-1112
(973) 592-9836
Mailing address
560 MORRIS ST, ORANGE, NJ 07050-1112
(973) 592-9836
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00326700
NJ
1041C0700X
Clinical Social Worker
44SC05967900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093201
SELF-ISSUED
—
Enumeration date
07/12/2022
Last updated
07/12/2022
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