Provider Demographics
NPI:1598311599
Name:FAMILIES ON THE LINE, LLC
Entity Type:Organization
Organization Name:FAMILIES ON THE LINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE-PAULE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DE VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-981-0113
Mailing Address - Street 1:779 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4015
Mailing Address - Country:US
Mailing Address - Phone:203-981-0113
Mailing Address - Fax:
Practice Address - Street 1:129 CHURCH ST STE 807
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2005
Practice Address - Country:US
Practice Address - Phone:203-981-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty