Provider Demographics
NPI:1093024028
Name:J S SOCIAL SERVICE, INC
Entity Type:Organization
Organization Name:J S SOCIAL SERVICE, INC
Other - Org Name:YOUTHTOWN USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-609-0022
Mailing Address - Street 1:12 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2711
Mailing Address - Country:US
Mailing Address - Phone:410-609-0022
Mailing Address - Fax:410-609-2042
Practice Address - Street 1:12 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-2711
Practice Address - Country:US
Practice Address - Phone:410-609-0022
Practice Address - Fax:410-609-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD038681041C0700X
MD145201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty