Provider Demographics
NPI:1912063462
Name:THE FAMILY CENTER AT MONTCLAIR
Entity Type:Organization
Organization Name:THE FAMILY CENTER AT MONTCLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIERZEJWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-857-5333
Mailing Address - Street 1:155 POMPTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2942
Mailing Address - Country:US
Mailing Address - Phone:973-857-5333
Mailing Address - Fax:973-857-5338
Practice Address - Street 1:155 POMPTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2942
Practice Address - Country:US
Practice Address - Phone:973-857-5333
Practice Address - Fax:973-857-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026298Medicaid