Healthcare Provider Details

I. General information

NPI: 1477600831
Provider Name (Legal Business Name): JEWISH FAMILY & CHILDREN'S SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 VANDERBILT AVE
NORWOOD MA
02062-5025
US

IV. Provider business mailing address

1430 MAIN ST
WALTHAM MA
02451-1623
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0405
  • Fax:
Mailing address:
  • Phone: 781-647-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELLEN LASH
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 781-647-5327