Organization
LEADING YOUTH THROUGH EXPERIENCE, LLC
Active
Organization
LEADING YOUTH THROUGH EXPERIENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON MARK ROSENBERG (EXECUTIVE DIRECTOR)
(732) 458-3201
Entity
Organization
Contact information
Practice address
448 19TH AVE, BRICK, NJ 08724
(732) 458-3201
(732) 458-3269
Mailing address
PO BOX D, BRICK, NJ 08723-0055
(732) 458-3201
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
44SC04652800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061913
—
NJ
Enumeration date
05/06/2007
Last updated
08/16/2007
Update your record
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