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General NPI Number Information
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NPI Number | 1194886705
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Entity Type | Organization
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Legal Business Name | SERV CENTERS OF NEW JERSEY, INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 NORTH AVENUE WEST
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City | CRANFORD
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State | NJ
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Zip | 07016
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Country | US
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Telephone | 908-276-3359
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Fax | 908-276-2472
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Provider Business Mailing Address
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Address Line | 380 SCOTCH RD
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City | W TRENTON
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State | NJ
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Zip | 08628
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Country | US
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Telephone | 609-406-0100
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Fax | 609-406-0307
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Authorized Official
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Title or Position | CEO
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Name | MR. GARY VAN NOSTRAND
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Credential |
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Telephone | 609-406-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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