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General NPI Number Information
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NPI Number | 1427589910
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE YOUTH AND FAMILY SERVICES
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 03/25/2017
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Provider Practice Location Address
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Address Line | 27 LIGHAM ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1814
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Country | US
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Telephone | 973-735-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 27 LIGHAM ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1814
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Country | US
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Telephone | 973-420-6209
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES COOK
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Credential | MBA
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Telephone | 973-420-6209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NJ
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