Provider Demographics
NPI:1619611464
Name:EMH FAMILY SERVICES PC
Entity Type:Organization
Organization Name:EMH FAMILY SERVICES PC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:845-656-3053
Mailing Address - Street 1:55 WALLS DR
Mailing Address - Street 2:STE 206
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5163
Mailing Address - Country:US
Mailing Address - Phone:203-689-8989
Mailing Address - Fax:
Practice Address - Street 1:55 WALLS DR
Practice Address - Street 2:STE 206
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5163
Practice Address - Country:US
Practice Address - Phone:845-656-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty