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General NPI Number Information
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NPI Number | 1689081309
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Entity Type | Organization
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Legal Business Name | THE YOUTH SUCCESS NETWORK LLC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 1150 NEWTON ST SUITE B
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2286
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Country | US
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Telephone | 888-897-6465
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Fax | 877-438-8976
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Provider Business Mailing Address
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Address Line | 1150 NEWTON ST SUITE B.
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2286
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Country | US
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Telephone | 888-897-6465
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Fax | 877-438-8976
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID SETSUO ISHIBASHI
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Credential |
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Telephone | 551-574-8739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0397318
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License Number State | NJ
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