| PG - Strengths Development Program | |
|
25 Church St Keyport NJ 07735-1508 | |
| (732) 217-1750 | |
| (732) 217-1749 |
| Full Name | PG - Strengths Development Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 25 Church St, Keyport, New Jersey |
| Authorized Official Name and Position | Lisa Dale Siroti (PRINCIPAL) |
| Authorized Official Contact | 7327700428 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| PG - Strengths Development Program 25 Church St Keyport NJ 07735-1508 Ph: (732) 217-1750 | PG - Strengths Development Program 25 Church St Keyport NJ 07735-1508 Ph: (732) 217-1750 |
| NPI Number | 1588983308 |
|---|---|
| Provider Enumeration Date | 05/18/2010 |
| Last Update Date | 12/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588983308 | NPI | - | NPPES |
| 0224031 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 44SC05262800 (New Jersey) | Primary |
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