Provider Demographics
NPI:1760709513
Name:LA VILLA MULTI-SERVICES AGENCY, INC.
Entity Type:Organization
Organization Name:LA VILLA MULTI-SERVICES AGENCY, INC.
Other - Org Name:LA VILLA AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:973-230-7181
Mailing Address - Street 1:663 MOUNT PROSPECT AVE STE 2
Mailing Address - Street 2:100-102 PASSAIC ST., PASSAIC, NJ 07055
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3166
Mailing Address - Country:US
Mailing Address - Phone:973-230-7181
Mailing Address - Fax:973-230-1782
Practice Address - Street 1:100-102 PASSAIC STREET
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-928-2280
Practice Address - Fax:973-928-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty