Healthcare Provider Details

I. General information

NPI: 1538208061
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 LAWNRIDGE RD
ORANGE NJ
07050-3011
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

Practice location:
  • Phone: 973-675-7902
  • Fax: 973-675-5201
Mailing address:
  • Phone: 973-482-8411
  • Fax: 973-482-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number50019G44Y1007
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number50019G44Y507
License Number StateNJ

VIII. Authorized Official

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