Provider Demographics
NPI:1386082907
Name:CATHOLIC CHARITIES DIOCESE OF METUCHEN
Entity type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF METUCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DESI
Authorized Official - Middle Name:
Authorized Official - Last Name:ISIDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-738-1323
Mailing Address - Street 1:26 SAFRAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3510
Mailing Address - Country:US
Mailing Address - Phone:732-738-1323
Mailing Address - Fax:732-738-3896
Practice Address - Street 1:26 SAFRAN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3510
Practice Address - Country:US
Practice Address - Phone:732-738-1323
Practice Address - Fax:732-738-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00142600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health