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Organization
PA MENTAL HEALTH PROFESSIONAL SRVCS LLC
Active
Organization
PA MENTAL HEALTH PROFESSIONAL SRVCS LLC
Active
Other names
PA Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIGUEL ANGEL MATOS LPC (CEO)
(908) 759-2376
Entity
Organization
Contact information
Practice address
410 BIRCH CT, NEW BRUNSWICK, NJ 08901-2693
(908) 759-2376
Mailing address
410 BIRCH CT, NEW BRUNSWICK, NJ 08901-2693
(908) 759-2376
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033399555
—
PA
Enumeration date
03/17/2023
Last updated
03/17/2023
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