| Leading Youth Through Experience, Llc | |
|
448 19th Ave Brick NJ 08724 | |
| (732) 458-3201 | |
| (732) 458-3269 |
| Full Name | Leading Youth Through Experience, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 448 19th Ave, Brick, New Jersey |
| Authorized Official Name and Position | Jason Mark Rosenberg (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7324583201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leading Youth Through Experience, Llc Po Box D Brick NJ 08723-0055 Ph: (732) 458-3201 | Leading Youth Through Experience, Llc 448 19th Ave Brick NJ 08724 Ph: (732) 458-3201 |
| NPI Number | 1225240633 |
|---|---|
| Provider Enumeration Date | 05/06/2007 |
| Last Update Date | 08/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225240633 | NPI | - | NPPES |
| 0061913 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 44SC04652800 (New Jersey) | Primary |
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