Organization
LEADING YOUTH THROUGH EXPERIENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MARK ROSENBERG (OWNER/EXECUTIVE DIRECTOR)
(732) 458-3201
Entity
Organization
Contact information
Practice address
2 ARROWHEAD CT, FREEHOLD, NJ 07728-9577
(732) 458-3201
(732) 458-3269
Mailing address
2 ARROWHEAD CT, FREEHOLD, NJ 07728-9577
(732) 458-3201
(732) 458-3269
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
172V00000X
Community Health Worker
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225240633
—
NJ
Enumeration date
04/19/2018
Last updated
04/19/2018
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