Organization
DEPARTMENT OF MENTAL HEALTH
Active
Other names
FITCHBURG - GARDNER CM
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BRODERICK (SITE DIRECTOR)
(978) 353-4433
Entity
Organization
Contact information
Practice address
515 MAIN ST, FITCHBURG, MA 01420
(978) 353-4433
Mailing address
25 STANIFORD ST, BOSTON, MA 02114
(617) 626-8040
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802348
—
MA
Enumeration date
04/24/2007
Last updated
07/18/2007
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