Provider Demographics
NPI:1942919477
Name:FAMILY MENTAL HEALTH SERVICES LLC INDEPENDENT CLINIC
Entity Type:Organization
Organization Name:FAMILY MENTAL HEALTH SERVICES LLC INDEPENDENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-588-2445
Mailing Address - Street 1:540 NORTH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7149
Mailing Address - Country:US
Mailing Address - Phone:908-588-2445
Mailing Address - Fax:908-558-0170
Practice Address - Street 1:540 NORTH AVE STE 4
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7149
Practice Address - Country:US
Practice Address - Phone:908-588-2445
Practice Address - Fax:908-558-0170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MENTAL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0866113Medicaid