Healthcare Provider Details

I. General information

NPI: 1649318445
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

101 E ATLANTIC AVE
HADDON HEIGHTS NJ
08035-1901
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

Practice location:
  • Phone: 856-672-0500
  • Fax: 856-672-1114
Mailing address:
  • Phone: 973-482-8411
  • Fax: 973-482-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number50019G44Y807
License Number StateNJ

VIII. Authorized Official

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