Healthcare Provider Details

I. General information

NPI: 1023158573
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 E 39TH ST
PATERSON NJ
07514-1105
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

Practice location:
  • Phone: 973-278-1465
  • Fax: 973-278-3288
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 Number1380
License Number StateNJ

VIII. Authorized Official

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