Provider Demographics
NPI:1295711778
Name:AFFILIATES IN CLINICAL SERVICES
Entity type:Organization
Organization Name:AFFILIATES IN CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC-BC
Authorized Official - Phone:908-454-7244
Mailing Address - Street 1:305 ROSEBERRY ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1600
Mailing Address - Country:US
Mailing Address - Phone:908-454-7244
Mailing Address - Fax:908-859-2109
Practice Address - Street 1:305 ROSEBERRY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1600
Practice Address - Country:US
Practice Address - Phone:908-454-7244
Practice Address - Fax:908-859-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ552515000OtherMAGELLAN
NJ552515000OtherMAGELLAN