Provider Demographics
NPI:1346291861
Name:JEWISH FAMILY SERVICE OF STAMFORD, INC.
Entity Type:Organization
Organization Name:JEWISH FAMILY SERVICE OF STAMFORD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:203-921-4161
Mailing Address - Street 1:733 SUMMER ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1081
Mailing Address - Country:US
Mailing Address - Phone:203-921-4161
Mailing Address - Fax:203-921-4169
Practice Address - Street 1:733 SUMMER ST
Practice Address - Street 2:SUITE 602
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1081
Practice Address - Country:US
Practice Address - Phone:203-921-4161
Practice Address - Fax:203-921-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0414101YM0800X
CT1041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004179942Medicaid
CTC02181Medicare PIN