Provider Demographics
NPI:1679703177
Name:FAMILY SERVICE LEAGUE, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE LEAGUE, INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:973-746-0800
Mailing Address - Street 1:204 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3409
Mailing Address - Country:US
Mailing Address - Phone:973-746-0800
Mailing Address - Fax:973-746-2822
Practice Address - Street 1:204 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3409
Practice Address - Country:US
Practice Address - Phone:973-746-0800
Practice Address - Fax:973-746-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00358600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637481Medicare PIN