Organization
MASSACHUSETTS MENTOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN JAMES LOVELADY (STATE DIRECTOR)
(862) 284-4565
Entity
Organization
Contact information
Practice address
1115 W CHESTNUT ST STE 202, BROCKTON, MA 02301-7501
(781) 326-4207
(781) 326-4654
Mailing address
1115 W CHESTNUT ST STE 202, BROCKTON, MA 02301-7501
(508) 824-1355
(508) 824-3732
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1615
MA
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1904469
—
MA
Enumeration date
03/16/2007
Last updated
08/21/2025
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