Provider Demographics
NPI:1699445429
Name:COOL MOM & DAD
Entity type:Organization
Organization Name:COOL MOM & DAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:609-789-7357
Mailing Address - Street 1:48 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3439
Mailing Address - Country:US
Mailing Address - Phone:609-789-7357
Mailing Address - Fax:
Practice Address - Street 1:48 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3439
Practice Address - Country:US
Practice Address - Phone:609-789-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)