Healthcare Provider Details

I. General information

NPI: 1568275741
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION RARITAN BAY AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861-3940
US

IV. Provider business mailing address

PO BOX 148
PERTH AMBOY NJ
08862-0148
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-3632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN CHARLES JOBIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 732-442-3632