SOUTH BROAD STREET COUNSELING SERVICES INC NPI 1003014663

Clinic/Center (Health Service) in Trenton, NJ

NPI 1003014663 Organization Clinic/Center Health Service

About SOUTH BROAD STREET COUNSELING SERVICES INC

South Broad Street Counseling Services Inc is a provider established in Trenton, New Jersey specializing in clinic/center (health service) . The NPI number of South Broad Street Counseling Services Inc is 1003014663 and was assigned on July 2007. The practitioner's primary taxonomy code is 261QH0100X with license number 2000283 (NJ). The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Mr. Clinton H Scott Phd (Executive Director)

NPI

1003014663

Provider NameSOUTH BROAD STREET COUNSELING SERVICES INC
Provider Location Address1418 SOUTH BROAD STREET TRENTON, NJ 08610
Provider Mailing Address1418 SOUTH BROAD STREET TRENTON, NJ 08610
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date07-05-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code261QH0100X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationHealth Service
License No.2000283
License StateNJ

Business Address

SOUTH BROAD STREET COUNSELING SERVICES INC
1418 SOUTH BROAD STREET
TRENTON, NJ
ZIP 08610
Phone: (609) 394-8000

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Mailing Address

SOUTH BROAD STREET COUNSELING SERVICES INC
1418 SOUTH BROAD STREET
TRENTON, NJ
ZIP 08610
Phone: (609) 394-8000



Authorized Official

Authorized Official NameMR. CLINTON H SCOTT PHD
Authorized Official TitleEXECUTIVE DIRECTOR
Authorized Official Phone(609) 394-8000

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0006033OTHER (01)NJ
8937401MEDICAID (05)NJ

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.