Organization
MARYVILLE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES O'BRIEN MSW, LCADC (CEO)
(856) 227-2717
Entity
Organization
Contact information
Practice address
707 N MAIN ST, GLASSBORO, NJ 08028-1605
(856) 863-3913
(856) 863-3917
Mailing address
707 N MAIN ST, GLASSBORO, NJ 08028-1605
(856) 863-3913
(856) 863-3917
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
23032
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7632304
—
NJ
Enumeration date
05/03/2007
Last updated
04/07/2010
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