Basic Information
| Provider Information | |||||||||
| NPI: | 1528274776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY & PSYCHOLOGICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1868 GREENTREE RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564244408 | ||||||||
| FaxNumber: | 8564249164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1868 GREENTREE RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080032031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564244408 | ||||||||
| FaxNumber: | 8564249164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | NEGRON | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8564244408 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 106H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0040509 | 05 | NJ | MEDICAID |