Provider Demographics
NPI:1023660230
Name:FAMILY AND CHILDREN'S ASSOCIATION
Entity type:Organization
Organization Name:FAMILY AND CHILDREN'S ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-804-1010
Mailing Address - Street 1:100 E OLD COUNTRY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4614
Mailing Address - Country:US
Mailing Address - Phone:516-804-1010
Mailing Address - Fax:
Practice Address - Street 1:100 E OLD COUNTRY RD STE 14
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4614
Practice Address - Country:US
Practice Address - Phone:516-804-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY AND CHILDREN'S ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-09
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty