Organization
COMMONWEALTH OF MASS-DDS
Active
Other names
GBA HARBOR AREA OFFICE
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE MAILLET (CHIEF FINANCIAL OFFICER)
(617) 727-5608
Entity
Organization
Contact information
Practice address
65 SPRAGUE ST, HYDE PARK, MA 02136-2061
(617) 360-2400
Mailing address
500 HARRISON AVE, BOSTON, MA 02118-2439
(617) 727-5608
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1813013
—
MA
Enumeration date
03/08/2007
Last updated
10/01/2009
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