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General NPI Number Information
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NPI Number | 1679469712
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Entity Type | Organization
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Legal Business Name | RADICAL JOY INC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 717 WASHINGTON ST
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City | DORCHESTER
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State | MA
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Zip | 02124-4411
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Country | US
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Telephone | 617-785-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 717 WASHINGTON ST
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City | DORCHESTER
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State | MA
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Zip | 02124-4411
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Country | US
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Telephone | 617-785-8954
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/HEAD CLINICIAN
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Name | MS. ALICIA RAHEMA MOOLTREY
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Credential | LICSW
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Telephone | 617-785-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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