Provider Demographics
NPI:1912958513
Name:FAMILY SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-569-0239
Mailing Address - Street 1:3073 ENGLISH CREEK AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9711
Mailing Address - Country:US
Mailing Address - Phone:609-569-0239
Mailing Address - Fax:609-569-1802
Practice Address - Street 1:312 E WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9565
Practice Address - Country:US
Practice Address - Phone:609-652-1600
Practice Address - Fax:609-652-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN/A101YM0800X
261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024201Medicaid
NJ0024201Medicaid