Provider Demographics
NPI:1730487505
Name:SOCIAL DEVELOPMENT COMMISSION-(YFDP)
Entity Type:Organization
Organization Name:SOCIAL DEVELOPMENT COMMISSION-(YFDP)
Other - Org Name:(YFDP)YOUTH AND FAMILY DEVELOPMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:CLEMENTS
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-906-2722
Mailing Address - Street 1:4041 N RICHARD'S STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212
Mailing Address - Country:US
Mailing Address - Phone:414-906-2700
Mailing Address - Fax:414-963-2691
Practice Address - Street 1:4041 N RICHARD'S STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-906-2700
Practice Address - Fax:414-963-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
WI2373251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management