Organization
REAL CHANGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK ERVIN HARPER MSW,LCSW (PRESIDENT/CEO)
(617) 223-7324
Entity
Organization
Contact information
Practice address
189 RUSKINDALE RD, MATTAPAN, MA 02126-1653
(617) 223-7324
Mailing address
189 RUSKINDALE RD, MATTAPAN, MA 02126-1653
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
214156
MA
251S00000X
Community/Behavioral Health Agency
Primary
214156
MA
253Z00000X
In Home Supportive Care Agency
214156
MA
Other
Enumeration date
09/30/2009
Last updated
12/07/2009
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