Healthcare Provider Details

I. General information

NPI: 1891969283
Provider Name (Legal Business Name): FAMILY SERVICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 ENGLISH CREEK AVE STE 3
EGG HARBOR TWP NJ
08234-9711
US

IV. Provider business mailing address

3073 ENGLISH CREEK AVE STE 3
EGG HARBOR TWP NJ
08234-9711
US

V. Phone/Fax

Practice location:
  • Phone: 609-569-0239
  • Fax: 609-569-1802
Mailing address:
  • Phone: 609-569-0239
  • Fax: 609-569-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. JENNIE ECHO
Title or Position: CHIEF OPERATING OFFICER
Credential: MHA, LNHA
Phone: 609-569-0239