Provider Demographics
NPI:1477956837
Name:FARIFIELD TOWNSHIP SCHOOL
Entity Type:Organization
Organization Name:FARIFIELD TOWNSHIP SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BA
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-453-1882
Mailing Address - Street 1:375 GOULDTOWN WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-7242
Mailing Address - Country:US
Mailing Address - Phone:856-453-1882
Mailing Address - Fax:856-453-7189
Practice Address - Street 1:375 GOULDTOWN WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-7242
Practice Address - Country:US
Practice Address - Phone:856-453-1882
Practice Address - Fax:856-453-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40611103T00000X
NJ538341104100000X
NJ40QA00518300225100000X
NJ46TR00264300225X00000X
NJ89331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6544908Medicaid