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NPI Code Detail

MEDICARE: CHILDREN'S SERVICES OF ROXBURY, INC.

MEDICARE: CHILDREN'S SERVICES OF ROXBURY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1124253794
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S SERVICES OF ROXBURY, INC.
Provider Business Mailing Address
First Line : 520 DUDLEY ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-2769
Country : US
Telephone Number : 617-445-6655
Fax Number : 617-445-0940
Provider Business Practice Location Address
First Line : 520 DUDLEY ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-2769
Country : US
Telephone Number : 617-445-6655
Fax Number : 617-445-0940
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MS. PAMELA A OGLETREE
Credential :
Telephone Number : 617-445-6655
Provider Enumeration Date : 05/26/2009
Last Update Date : 05/26/2009

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Directions to “CHILDREN'S SERVICES OF ROXBURY, INC. ” Practice Location

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