Provider Demographics
NPI:1003831892
Name:JEWISH COMMUNITY ASSOCIATION OF AUSTIN
Entity Type:Organization
Organization Name:JEWISH COMMUNITY ASSOCIATION OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-250-1043
Mailing Address - Street 1:11940 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 110 SOUTH
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2327
Mailing Address - Country:US
Mailing Address - Phone:512-250-1043
Mailing Address - Fax:
Practice Address - Street 1:11940 JOLLYVILLE RD
Practice Address - Street 2:SUITE 110 SOUTH
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2327
Practice Address - Country:US
Practice Address - Phone:512-250-1043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty