MEDICARE: JEWISH FAMILY SERVICE OF STAMFORD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0414	CT
2	106H00000X	Marriage & Family Therapist
3	1041C0700X	Clinical Social Worker		CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346291861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICE OF STAMFORD, INC.

Provider Business Mailing Address
First Line	:	733 SUMMER ST
Second Line	:	SUITE 602
City	:	STAMFORD
State	:	CT
Zip	:	06901-1081
Country	:	US
Telephone Number	:	203-921-4161
Fax Number	:	203-921-4169

Provider Business Practice Location Address
First Line	:	733 SUMMER ST
Second Line	:	SUITE 602
City	:	STAMFORD
State	:	CT
Zip	:	06901-1081
Country	:	US
Telephone Number	:	203-921-4161
Fax Number	:	203-921-4169

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MATT GREENBERG
Credential	:	MSW
Telephone Number	:	203-921-4161

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/06/2017

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Directions to “JEWISH FAMILY SERVICE OF STAMFORD, INC. ” Practice Location

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