Provider Demographics
NPI:1861630923
Name:CHARLES LEIGHTON ASSOC LLC
Entity Type:Organization
Organization Name:CHARLES LEIGHTON ASSOC LLC
Other - Org Name:THE HEART GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CGP
Authorized Official - Phone:973-851-5095
Mailing Address - Street 1:45 CAREY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 CAREY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1443
Practice Address - Country:US
Practice Address - Phone:973-851-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046722001041C0700X
NY045106-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty