Provider Demographics
NPI:1093933343
Name:CONNECT FAMILY CENTER INC
Entity Type:Organization
Organization Name:CONNECT FAMILY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-504-3694
Mailing Address - Street 1:4202 ROUTE 130
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2509
Mailing Address - Country:US
Mailing Address - Phone:609-871-4442
Mailing Address - Fax:609-871-2487
Practice Address - Street 1:4202 ROUTE 130
Practice Address - Street 2:SUITE # 6
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2509
Practice Address - Country:US
Practice Address - Phone:609-871-4442
Practice Address - Fax:609-871-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013475001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016721Medicaid