Provider Demographics
NPI:1316479645
Name:SAVIA COMMUNITY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SAVIA COMMUNITY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-699-0508
Mailing Address - Street 1:116 TERRACE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644
Mailing Address - Country:US
Mailing Address - Phone:201-699-0508
Mailing Address - Fax:201-431-7343
Practice Address - Street 1:116 TERRACE AVENUE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644
Practice Address - Country:US
Practice Address - Phone:201-699-0508
Practice Address - Fax:201-431-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0522520Medicaid