Provider Demographics
NPI:1841247053
Name:FAMILY GUIDANCE CENTER CORPORTION
Entity type:Organization
Organization Name:FAMILY GUIDANCE CENTER CORPORTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANNT CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-587-7044
Mailing Address - Street 1:120 JOHN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542
Mailing Address - Country:US
Mailing Address - Phone:609-924-2098
Mailing Address - Fax:609-924-7826
Practice Address - Street 1:2300 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3007
Practice Address - Country:US
Practice Address - Phone:609-587-7044
Practice Address - Fax:609-588-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ610515Medicaid
NJ610515Medicaid