Provider Demographics
NPI:1689758955
Name:JEWISH BOARD OF FAMILY AND CHILDREN SERVICES
Entity Type:Organization
Organization Name:JEWISH BOARD OF FAMILY AND CHILDREN SERVICES
Other - Org Name:PRIDE OF JUDEA
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENCED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-961-3521
Mailing Address - Street 1:43-06 159TH STREET,
Mailing Address - Street 2:B4
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-423-6200
Mailing Address - Fax:718-423-9762
Practice Address - Street 1:JEWISH BOARD AND CHILDREN AND FAMILY SERVICES
Practice Address - Street 2:PRIDE OF JUDEA COMMUNITY SERVICES (CLINIC)
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-423-6200
Practice Address - Fax:718-423-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071-000-1251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization