Provider Demographics
NPI:1629105515
Name:PUERTO RICAN FAMILY INSTITUTE, INC.
Entity Type:Organization
Organization Name:PUERTO RICAN FAMILY INSTITUTE, INC.
Other - Org Name:PUERTO RICAN FAMILY INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-610-1446
Mailing Address - Street 1:35 JOURNAL SQUARE
Mailing Address - Street 2:SUITE 528
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4029
Mailing Address - Country:US
Mailing Address - Phone:201-610-1446
Mailing Address - Fax:201-610-9426
Practice Address - Street 1:35 JOURNAL SQUARE
Practice Address - Street 2:SUITE 528
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4029
Practice Address - Country:US
Practice Address - Phone:201-610-1446
Practice Address - Fax:201-610-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000752103T00000X
NJ10011-03-04261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8547602Medicaid