Provider Demographics
NPI:1477004604
Name:YOUTH CONSULTATION SERVICE, INC
Entity Type:Organization
Organization Name:YOUTH CONSULTATION SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRES/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFALCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-482-8411
Mailing Address - Street 1:284 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4003
Mailing Address - Country:US
Mailing Address - Phone:973-482-8411
Mailing Address - Fax:
Practice Address - Street 1:284 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4003
Practice Address - Country:US
Practice Address - Phone:973-482-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0532746Medicaid