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
208 E 10TH AVE, ROSELLE, NJ 07203-2012
(908) 259-8950
(908) 259-8951
Mailing address
333 7TH AVE FL 9, NEW YORK, NY 10001-5827
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
GH1131A
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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