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NPI Code Detail

MEDICARE: KALEIDOSCOPE DISABILITIES INC

MEDICARE: KALEIDOSCOPE DISABILITIES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor44SC0136340NJ

General Provider Information

NPI Number : 1609007244
Entity Type Code : Organization
Provider Name (Legal Business Name) : KALEIDOSCOPE DISABILITIES INC
Provider Business Mailing Address
First Line : 1285 BROAD ST
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-3045
Country : US
Telephone Number : 201-259-4592
Fax Number : 973-338-4440
Provider Business Practice Location Address
First Line : 1285 BROAD ST
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-3045
Country : US
Telephone Number : 201-259-4592
Fax Number : 973-338-4440
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. QUINCEY S HOLLOWAY
Credential : LSW
Telephone Number : 201-259-4592
Provider Enumeration Date : 07/30/2009
Last Update Date : 07/30/2009

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Directions to “KALEIDOSCOPE DISABILITIES INC ” Practice Location

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