Healthcare Provider Details

I. General information

NPI: 1073406062
Provider Name (Legal Business Name): PROACTIVE FAMILIES ADVOCACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST STE B
WORCESTER MA
01610-5406
US

IV. Provider business mailing address

900 MAIN ST STE B
WORCESTER MA
01610-5406
US

V. Phone/Fax

Practice location:
  • Phone: 774-234-6075
  • Fax:
Mailing address:
  • Phone: 774-234-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS KAYLA BAILLARGEON
Title or Position: CEO
Credential: BA IN HUMAN SERVICES
Phone: 774-321-0854