Healthcare Provider Details

I. General information

NPI: 1326107376
Provider Name (Legal Business Name): JEWISH FAMILY SERVICE OF NEW HAVEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 WHALLEY AVE
NEW HAVEN CT
06515
US

IV. Provider business mailing address

1440 WHALLEY AVE
NEW HAVEN CT
06515
US

V. Phone/Fax

Practice location:
  • Phone: 203-389-5599
  • Fax: 203-389-5904
Mailing address:
  • Phone: 203-389-5599
  • Fax: 203-389-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberC-0161
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC-0161
License Number StateCT

VIII. Authorized Official

Name: MRS. AMY G. RASHBA
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 203-389-5599