Organization
COMMONWEALTH OF MASSACHUSETTS
Active
Parent organization
COMMONWEALTH OF MASSACHUSETS
Other names
SOUTH VALLEY AREA OFFICE CM, DDS SOUTH VALLEY AREA OFFICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF MASSACHUSETS
Authorized official
DYLAN LATTIMORE (DEPUTY COMMISSIONER OF ADMINSTRAT)
(857) 408-0675
Entity
Organization
Contact information
Practice address
14 MECHANIC ST, SUITE 320, SOUTHBRIDGE, MA 01550
(508) 764-0751
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
—
110000085G
—
MA
05
—
1813242
—
MA
Enumeration date
04/11/2007
Last updated
03/19/2026
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