Individual
JON VAN RADER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
425 PLEASANT ST, BROCKTON, MA 02301-2533
(508) 272-7561
(508) 584-5402
Mailing address
425 PLEASANT ST, BROCKTON, MA 02301-2533
(508) 272-7561
(508) 584-5402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11760
MA
Other
Enumeration date
02/06/2014
Last updated
08/07/2014
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