Provider Demographics
NPI:1386024958
Name:FAMILY ADVOCACY CENTER
Entity Type:Organization
Organization Name:FAMILY ADVOCACY CENTER
Other - Org Name:BAYSTATE CHILDREN'S HOSPTIAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL RESEARCH & DEVELOPMENT MAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOZNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:413-794-6630
Mailing Address - Street 1:50 MAPLE ST
Mailing Address - Street 2:FAMILY ADVOCACY CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 MAPLE ST
Practice Address - Street 2:FAMILY ADVOCACY CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1979
Practice Address - Country:US
Practice Address - Phone:413-794-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health