Provider Demographics
NPI:1538505490
Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Other - Org Name:EARLY INTERVENTION SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAO-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-394-5181
Mailing Address - Street 1:10 SOUTHARD STREET
Mailing Address - Street 2:CATHOLIC CHARITIES
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609
Mailing Address - Country:US
Mailing Address - Phone:609-396-4557
Mailing Address - Fax:
Practice Address - Street 1:833 CASS ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-2405
Practice Address - Country:US
Practice Address - Phone:609-396-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health