Get in Touch

Please use the form below to send us a message. We’ll get back to you as soon as possible!

If you need to contact the office directly, please call Katiana Defendre.
Phone: (973) 618-3373
Fax: (973) 618-3943

Required field marked by *
Child Name*
First Last
Child's DOB*
MM slash DD slash YYYY
Child Age*
Child Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent's Phone Number*
Parent's Email Address*
How were you referred to center?
Description of types of services child is already receiving*
What services are you most interested in?
Three behaviors (if any) you would like to see decreased
Three skills you would like to see improved in your child
Five things your child enjoys the most
Child's strengths
Intended funding source: Insurance, School district or Private funding
Type of services interested in: Full day placement, home services
Comments
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