Organization
COMMONWEALTH OF MASSACHUSETTS
Active
Parent organization
COMMONWEALTH OF MASSACHUSETS
Other names
DDS NORTH CENTRAL AREA OFFICE, NORTH CENTRAL AREA OFFICE CM
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF MASSACHUSETS
Authorized official
DYLAN LATTIMORE (DEPUTY COMMISSIONER OF ADMINSTRATI)
(857) 408-0675
Entity
Organization
Contact information
Practice address
49 NURSERY LANE, FITCHBURG, MA 01420
(978) 342-2140
Mailing address
40 BROAD STREET, 4TH FLOOR, BOSTON, MA 02109
(617) 727-5608
(617) 624-7577
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000085H
—
MA
05
—
1813277
—
MA
Enumeration date
04/11/2007
Last updated
03/19/2026
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