Provider Demographics
NPI:1376673814
Name:FAMILY SERVICE BUREAU OF NEWARK
Entity Type:Organization
Organization Name:FAMILY SERVICE BUREAU OF NEWARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHI SHU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:973-412-2056
Mailing Address - Street 1:274 S ORANGE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2419
Mailing Address - Country:US
Mailing Address - Phone:973-412-2056
Mailing Address - Fax:973-484-3452
Practice Address - Street 1:274 S ORANGE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2419
Practice Address - Country:US
Practice Address - Phone:973-412-2056
Practice Address - Fax:973-484-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101050204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021105Medicaid
NJ7705603Medicaid
NJ0021105Medicaid
NJ0021105Medicaid