=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144619446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S AID AND FAMILY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2015
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 346 DUVIER PL
-----------------------------------------------------
City | MAYWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07607-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-843-1568
-----------------------------------------------------
Fax | 201-843-1572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 ROBIN RD
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-261-2800
-----------------------------------------------------
Fax | 201-634-3672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER & CFO
-----------------------------------------------------
Name | MS. JOANNE E MANDRY
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 201-740-7050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------