Healthcare Provider Details

I. General information

NPI: 1518051572
Provider Name (Legal Business Name): JEWISH FAMILY SERVICE AGENCY OF CENTRAL JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1325
US

IV. Provider business mailing address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1325
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-8375
  • Fax: 908-352-8858
Mailing address:
  • Phone: 908-352-8375
  • Fax: 908-352-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. THOMAS M BECK
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 908-352-8375