Organization
SOUTH BROAD STREET COUNSELING SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINTON H SCOTT PHD (EXECUTIVE DIRECTOR)
(609) 394-8000
Entity
Organization
Contact information
Practice address
1418 SOUTH BROAD STREET, TRENTON, NJ 08610
(609) 394-8000
Mailing address
1418 SOUTH BROAD STREET, TRENTON, NJ 08610
(609) 394-8000
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
2000283
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006033
SAI PROVIDER NUMBER
NJ
05
—
8937401
—
NJ
Enumeration date
07/05/2007
Last updated
08/22/2020
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