Provider Demographics
NPI:1235937269
Name:YOUTH DEVELOPMENT CLINIC OF NEWARK
Entity type:Organization
Organization Name:YOUTH DEVELOPMENT CLINIC OF NEWARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KITZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-494-5801
Mailing Address - Street 1:500 BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3112
Mailing Address - Country:US
Mailing Address - Phone:973-623-5080
Mailing Address - Fax:
Practice Address - Street 1:500 BROAD ST FL 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3112
Practice Address - Country:US
Practice Address - Phone:973-623-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH DEVELOPMENT CLINIC OF NEWARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health