Organization
THE COMMUNITY YMCA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEEANN WAGNER LPC (DIRECTOR)
(732) 290-9040
Entity
Organization
Contact information
Practice address
201 BROAD ST, MATAWAN, NJ 07747-3226
(732) 290-9040
(732) 566-0433
Mailing address
166 MAIN ST, MATAWAN, NJ 07747-3104
(732) 290-9040
(732) 566-0433
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
100051204
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0517682
—
NJ
Enumeration date
01/05/2017
Last updated
01/05/2017
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