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General NPI Number Information
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NPI Number | 1205154770
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Entity Type | Organization
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Legal Business Name | GROWTH OPPORTUNITY GUIDANCE CENTER LLC
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Dates
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Enumeration Date | 05/09/2010
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Last Update Date | 05/09/2010
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Provider Practice Location Address
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Address Line | 100 DAVIDSON AVE SUITE 203
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City | SOMERSET
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State | NJ
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Zip | 08873-1312
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Country | US
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Telephone | 732-789-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EVERETT DR
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City | NEWTOWN
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State | PA
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Zip | 18940-1655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAURIE WEINBERG
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Credential | MSW
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Telephone | 723-789-4371
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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 |
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License Number State | NJ
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