Healthcare Provider Details

I. General information

NPI: 1649548520
Provider Name (Legal Business Name): JEWISH BOARD OF FAMILIES AND CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

77 CHICAGO AVE.
STATEN ISLAND NY
10305-3757
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7828
  • Fax:
Mailing address:
  • Phone: 718-442-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number051263-1
License Number StateNY

VIII. Authorized Official

Name: MS. KENDE KENDE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 718-442-7828