Provider Demographics
NPI:1689159329
Name:JEWISH FAMILY & CHILDREN'S SERVICE
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDREN'S SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF BILLING & REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-693-5582
Mailing Address - Street 1:1430 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1623
Mailing Address - Country:US
Mailing Address - Phone:781-647-5327
Mailing Address - Fax:781-693-5581
Practice Address - Street 1:18 SHEPARD ST STE 280
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3416
Practice Address - Country:US
Practice Address - Phone:617-224-4127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903713Medicaid