Organization
WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC L MASI (CEO)
(508) 879-9800
Entity
Organization
Contact information
Practice address
118 CENTRAL ST, WALTHAM, MA 02453-5465
(781) 891-0556
Mailing address
75 FOUNTAIN ST, FRAMINGHAM, MA 01702-6210
(508) 879-9800
(508) 875-1348
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
0592
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1803689
—
MA
01
—
6119935
HARVARD PILGRIM
MA
01
—
8710897
CIGNA
MA
01
—
EI0019
BLUE CROSS BLE SHIELD
MA
Enumeration date
04/24/2007
Last updated
08/22/2020
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