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General NPI Number Information
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NPI Number | 1750504064
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF DEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | SO VALLEY CM 79 NOTHE ST STE 2
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 508-764-5304
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Fax |
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Provider Business Mailing Address
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Address Line | 500 HARRISON AVE
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City | BOSTON
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State | MA
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Zip | 02118-2439
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Country | US
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Telephone | 617-624-7870
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Fax |
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Authorized Official
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Title or Position | C F O
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Name | JEANETTE MAILLET
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Credential |
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Telephone | 617-624-7814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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