Provider Demographics
NPI:1760994909
Name:CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC
Entity Type:Organization
Organization Name:CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-629-7939
Mailing Address - Street 1:333 7TH AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:#2 E. FRANCIS STREET
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:848-233-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH2398320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities