Healthcare Provider Details

I. General information

NPI: 1205975885
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 BLOOMFIELD AVE
FAIRFIELD NJ
07004-3705
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

Practice location:
  • Phone: 973-227-4458
  • Fax: 973-227-4866
Mailing address:
  • Phone: 973-482-8411
  • Fax: 973-482-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number4080
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD MINGOIA
Title or Position: PRESIDENT CEO
Credential:
Phone: 973-482-8411