Provider Demographics
NPI:1598136756
Name:FAMILY SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:508-678-7542
Mailing Address - Street 1:151 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3201
Mailing Address - Country:US
Mailing Address - Phone:508-678-7542
Mailing Address - Fax:508-676-3699
Practice Address - Street 1:151 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3201
Practice Address - Country:US
Practice Address - Phone:508-678-7542
Practice Address - Fax:508-676-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization