Provider Demographics
NPI:1578723987
Name:MAPLE SHADE YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MAPLE SHADE YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:JAXON
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-742-7400
Mailing Address - Street 1:23704 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2101
Mailing Address - Country:US
Mailing Address - Phone:410-742-7400
Mailing Address - Fax:
Practice Address - Street 1:23704 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837-2101
Practice Address - Country:US
Practice Address - Phone:410-742-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138090700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health