Provider Demographics
NPI:1104136795
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-266-7998
Mailing Address - Street 1:590 NORTH 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2522
Mailing Address - Country:US
Mailing Address - Phone:973-266-7998
Mailing Address - Fax:973-596-4030
Practice Address - Street 1:249 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3906
Practice Address - Country:US
Practice Address - Phone:201-798-9957
Practice Address - Fax:201-333-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101070704A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)