1043337231 NPI number — COMMONWEALTH OF MASSACHUSETTS

Table of content: (NPI 1043337231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043337231 NPI number — COMMONWEALTH OF MASSACHUSETTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH OF MASSACHUSETTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEPARTMENT OF MENTAL HEALTH - ESSEX NORTH AREA OFFICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043337231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 UNION ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01840-1866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-738-4500
Provider Business Mailing Address Fax Number:
978-738-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 UNION ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01840-1866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-738-4500
Provider Business Practice Location Address Fax Number:
978-738-4559
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
SITE DIRECTOR
Authorized Official Telephone Number:
978-738-4500

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1802801 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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