Organization
CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MAZZOCCO (ASSISTANT EXECUTIVE DIRECTOR)
(212) 629-7939
Entity
Organization
Contact information
Practice address
15 CAROL LN, CLIFTON, NJ 07012-2309
(973) 472-1459
(973) 472-2742
Mailing address
333 7TH AVE FL 9, NEW YORK, NY 10001-5827
(212) 629-7939
(212) 239-2211
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
GH721
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0471224
—
NJ
Enumeration date
04/17/2017
Last updated
04/17/2017
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