Organization
THE KEY PROGRAM, INCORPORATED.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM LYTTLE (PRESIDENT)
(508) 877-3690
Entity
Organization
Contact information
Practice address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
(413) 788-6925
Mailing address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
(413) 788-6925
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
4389
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306839
—
MA
01
—
M17759
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/12/2007
Last updated
06/12/2013
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