Provider Demographics
NPI:1689977233
Name:YOUTH CONSULTATION SERVICE
Entity Type:Organization
Organization Name:YOUTH CONSULTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGOIA
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:973-482-2907
Practice Address - Street 1:711 32ND ST
Practice Address - Street 2:SUITE 3
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2418
Practice Address - Country:US
Practice Address - Phone:201-865-8574
Practice Address - Fax:201-865-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0246557Medicaid