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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
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