Provider Demographics
NPI:1316207251
Name:CATHOLIC CHARITIES-DIOCESE OF METUCHEN
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES-DIOCESE OF METUCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN I
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-826-9160
Mailing Address - Street 1:105 ELM AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3216
Mailing Address - Country:US
Mailing Address - Phone:732-943-2404
Mailing Address - Fax:
Practice Address - Street 1:271 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4005
Practice Address - Country:US
Practice Address - Phone:732-826-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center