Provider Demographics
NPI:1356633416
Name:CENTER FOR FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, DSW
Authorized Official - Phone:856-964-1990
Mailing Address - Street 1:584 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1324
Mailing Address - Country:US
Mailing Address - Phone:856-964-1990
Mailing Address - Fax:856-964-0242
Practice Address - Street 1:17 DELSEA DR S
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2620
Practice Address - Country:US
Practice Address - Phone:856-881-5511
Practice Address - Fax:856-881-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10002-05-04251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0258474Medicaid