Provider Demographics
NPI:1861904963
Name:JEWISH FAMILY SERVICE OF METROWEST
Entity type:Organization
Organization Name:JEWISH FAMILY SERVICE OF METROWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SQUADRON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-765-9050
Mailing Address - Street 1:256 COLUMBIA TURNPIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-765-9050
Mailing Address - Fax:973-765-0195
Practice Address - Street 1:256 COLUMBIA TURNPIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-076-5905
Practice Address - Fax:973-765-0195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH FAMILY SERVICE OF METROWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0428591Medicaid