Provider Demographics
NPI:1093335986
Name:PROFESSIONAL SERVICES FOR FAMILIES
Entity Type:Organization
Organization Name:PROFESSIONAL SERVICES FOR FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AUREA R
Authorized Official - Middle Name:CORDOVA
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:347-226-0023
Mailing Address - Street 1:805 PLEASANT HILL RD NW UNIT 243
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2886
Mailing Address - Country:US
Mailing Address - Phone:347-226-0023
Mailing Address - Fax:
Practice Address - Street 1:805 PLEASANT HILL RD NW UNIT 243
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2886
Practice Address - Country:US
Practice Address - Phone:347-226-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty