Healthcare Provider Details

I. General information

NPI: 1205559747
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 BROADWAY
NEWARK NJ
07104-4003
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. TARA A AUGUSTINE
Title or Position: PRESIDENT / CEO
Credential: LCSW
Phone: 201-678-1312