Provider Demographics
NPI:1063645844
Name:TOWN OF WESTBOROUGH
Entity Type:Organization
Organization Name:TOWN OF WESTBOROUGH
Other - Org Name:WESTBOROUGH YOUTH AND FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-366-3030
Mailing Address - Street 1:34 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-3090
Mailing Address - Fax:508-366-3089
Practice Address - Street 1:45 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-3090
Practice Address - Fax:508-366-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC3670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty