| Organization Name: | 169 N STEVENS INC |
| NPI Number: | 1225255961 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | D MICHAEL ASTARITA (PRESIDENT/PRIMARY THERAPIST) |
| Mailing Address: | 147 N Broadway South Amboy |
| State: | NJ US |
| Postal Code: | 088791639 |
| Phone Number: | 7325251149 |
| Fax Number: | 7327276757 |
| NPI Enumeration Date: | 04/20/2007 |
| NPI Last Update Date: | 08/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00112100 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |