=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194152850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIDS RESOURCE FOUNDATION FOR CHILDREN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2013
-----------------------------------------------------
Last Update Date | 09/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 ACADEMY ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-643-0400
-----------------------------------------------------
Fax | 973-242-3583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 ACADEMY ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-643-0400
-----------------------------------------------------
Fax | 973-242-3583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. KEVIN ZEALAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-643-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------