Individual
ALI SELASSIE BOOTHE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 MADISON ST, WORCESTER, MA 01608-2058
(774) 530-6363
Mailing address
3 MAY ST, WORCESTER, MA 01610-1422
(774) 530-6363
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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