Provider Demographics
NPI:1386830867
Name:PERSONAL DISCOVERIES
Entity Type:Organization
Organization Name:PERSONAL DISCOVERIES
Other - Org Name:WARREN COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FUSARO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:908-454-0006
Mailing Address - Street 1:1 SHIMER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SHIMER BLVD
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-3723
Practice Address - Country:US
Practice Address - Phone:908-454-0006
Practice Address - Fax:908-454-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health