Provider Demographics
NPI:1083942049
Name:SISTERHOOD ON THE MOVE
Entity Type:Organization
Organization Name:SISTERHOOD ON THE MOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MM
Authorized Official - Phone:617-296-5976
Mailing Address - Street 1:47 ORLANDO ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1722
Mailing Address - Country:US
Mailing Address - Phone:617-296-5976
Mailing Address - Fax:
Practice Address - Street 1:47 ORLANDO ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1722
Practice Address - Country:US
Practice Address - Phone:617-296-5976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty