Provider Demographics
NPI:1679953210
Name:CONSCIOUS CONTACT
Entity Type:Organization
Organization Name:CONSCIOUS CONTACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ASSINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:856-863-3549
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-0462
Mailing Address - Country:US
Mailing Address - Phone:856-863-3549
Mailing Address - Fax:
Practice Address - Street 1:12 GIRARD RD S
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2160
Practice Address - Country:US
Practice Address - Phone:856-863-3549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00215300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health