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General NPI Number Information
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NPI Number | 1417444076
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Entity Type | Organization
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Legal Business Name | LEADING YOUTH THROUGH EXPERIENCE, LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 2 ARROWHEAD CT
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City | FREEHOLD
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State | NJ
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Zip | 07728-9577
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Country | US
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Telephone | 732-458-3201
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Fax | 732-458-3269
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Provider Business Mailing Address
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Address Line | 2 ARROWHEAD CT
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City | FREEHOLD
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State | NJ
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Zip | 07728-9577
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Country | US
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Telephone | 732-458-3201
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Fax | 732-458-3269
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | JASON MARK ROSENBERG
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Credential |
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Telephone | 732-458-3201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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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 |
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Taxonomy #5
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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