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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