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General NPI Number Information
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NPI Number | 1124107545
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Entity Type | Organization
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Legal Business Name | CREATIVE CONSULTING SERVICES, INC.
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67 CRYSTAL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1125
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Country | US
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Telephone | 732-409-3003
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Fax | 732-409-3013
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Provider Business Mailing Address
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Address Line | 67 CRYSTAL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1125
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Country | US
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Telephone | 732-409-3003
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Fax | 732-409-3013
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWIN MELENDEZ
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Credential | LCSW
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Telephone | 732-409-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC000835400
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License Number State | NJ
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