Provider Demographics
NPI:1124088638
Name:JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED
Entity type:Organization
Organization Name:JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:FRIEDMAN
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-459-4640
Mailing Address - Street 1:5000 CORPORATE WOODS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4429
Mailing Address - Country:US
Mailing Address - Phone:757-459-4640
Mailing Address - Fax:757-459-4643
Practice Address - Street 1:260 GRAYSON RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4345
Practice Address - Country:US
Practice Address - Phone:757-459-4640
Practice Address - Fax:757-459-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAW58996Medicare UPIN
C02752Medicare PIN