Provider Demographics
NPI:1609925817
Name:FAMILY SERVICE SOCIETY INC
Entity Type:Organization
Organization Name:FAMILY SERVICE SOCIETY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-962-3148
Mailing Address - Street 1:280 PRINCETON AVE EXT
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1524
Mailing Address - Country:US
Mailing Address - Phone:607-962-3148
Mailing Address - Fax:607-962-8422
Practice Address - Street 1:280 PRINCETON AVE EXT
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1524
Practice Address - Country:US
Practice Address - Phone:607-962-3148
Practice Address - Fax:607-962-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52938AMedicare UPIN