| 4th And Grove Llc | |
|
480 Defrancesco Cir Glassboro NJ 08028-4906 | |
| (856) 441-5216 | |
| Not Available |
| Full Name | 4th And Grove Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 480 Defrancesco Cir, Glassboro, New Jersey |
| Authorized Official Name and Position | Rosana Gilles-lamontagne (OWNER) |
| Authorized Official Contact | 8564415216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 4th And Grove Llc Po Box 752 Glassboro NJ 08028-0752 Ph: (856) 441-5216 | 4th And Grove Llc 480 Defrancesco Cir Glassboro NJ 08028-4906 Ph: (856) 441-5216 |
| NPI Number | 1831762228 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 07/22/2021 |
| Certification Date | 07/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831762228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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