MEDICARE: YOUTH CONSULTATION SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881739035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH CONSULTATION SERVICE INC

Provider Business Mailing Address
First Line	:	284 BROADWAY
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-4003
Country	:	US
Telephone Number	:	973-482-8411
Fax Number	:	973-482-2907

Provider Business Practice Location Address
First Line	:	284 BROADWAY
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-4003
Country	:	US
Telephone Number	:	973-482-8411
Fax Number	:	973-482-2907

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. RICHARD MINGOIA
Credential	:
Telephone Number	:	973-482-8411

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/06/2008

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Directions to “YOUTH CONSULTATION SERVICE INC ” Practice Location

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