Healthcare Provider Details

I. General information

NPI: 1275959587
Provider Name (Legal Business Name): JEWISH FAMILY SERVICE OF ATLANTIC COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 N JEROME AVE
MARGATE CITY NJ
08402-1527
US

IV. Provider business mailing address

607 N JEROME AVE
MARGATE CITY NJ
08402-1527
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-1108
  • Fax:
Mailing address:
  • Phone: 609-822-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00435900
License Number StateNJ

VIII. Authorized Official

Name: LISA FLASH
Title or Position: BILLING COORDINATOR
Credential:
Phone: 609-822-1108