Provider Demographics
NPI:1346542891
Name:HISPANIC FAMILY CENTER OF SOUTHERN NJ INC
Entity Type:Organization
Organization Name:HISPANIC FAMILY CENTER OF SOUTHERN NJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:856-541-6985
Mailing Address - Street 1:35 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-2210
Mailing Address - Country:US
Mailing Address - Phone:856-541-6985
Mailing Address - Fax:856-963-2663
Practice Address - Street 1:2700 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2427
Practice Address - Country:US
Practice Address - Phone:856-365-7393
Practice Address - Fax:856-365-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40305-01-04251S00000X
NJ40305-01-05251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5353203Medicaid