Provider Demographics
NPI:1457586794
Name:CHILD & FAMILY GUIDANCE CENTER ADDITION SERVICES INC
Entity type:Organization
Organization Name:CHILD & FAMILY GUIDANCE CENTER ADDITION SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-691-9191
Mailing Address - Street 1:106 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1422
Mailing Address - Country:US
Mailing Address - Phone:845-691-9191
Mailing Address - Fax:845-691-9339
Practice Address - Street 1:106 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1422
Practice Address - Country:US
Practice Address - Phone:845-691-9191
Practice Address - Fax:845-691-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067661104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty