Provider Demographics
NPI:1003979014
Name:CATHOLIC CHARITABLE BUREAU OF THE ARCHDIOCESE OF BOSTON, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITABLE BUREAU OF THE ARCHDIOCESE OF BOSTON, INC.
Other - Org Name:CATHOLIC CHARITIES FCGC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-464-8569
Mailing Address - Street 1:275 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1943
Mailing Address - Country:US
Mailing Address - Phone:617-464-8500
Mailing Address - Fax:789-777-4242
Practice Address - Street 1:275 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1943
Practice Address - Country:US
Practice Address - Phone:617-464-8569
Practice Address - Fax:978-777-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4082251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300105Medicaid
MA1311158Medicaid
MA110024365PMedicaid
MA1300105Medicaid