Healthcare Provider Details

I. General information

NPI: 1033248034
Provider Name (Legal Business Name): CATHOLIC CHARITIES, DIOCESE OF METUCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 SMITH ST
PERTH AMBOY NJ
08861-4005
US

IV. Provider business mailing address

319 MAPLE ST
PERTH AMBOY NJ
08861-4101
US

V. Phone/Fax

Practice location:
  • Phone: 732-826-9160
  • Fax:
Mailing address:
  • Phone: 732-324-8200
  • Fax: 732-324-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIO J COTO
Title or Position: ASSISTANT EXECUTIVE DIRECTOR
Credential:
Phone: 732-324-8200