Healthcare Provider Details

I. General information

NPI: 1205813540
Provider Name (Legal Business Name): CHILD & FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 PLEASANT ST
NEW BEDFORD MA
02740-6728
US

IV. Provider business mailing address

1061 PLEASANT ST
NEW BEDFORD MA
02740-6728
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-8572
  • Fax: 508-991-8618
Mailing address:
  • Phone: 508-996-8572
  • Fax: 508-991-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. JOHN R JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 508-996-8572