Provider Demographics
NPI:1114452828
Name:COMMUNITY SERVICES INSTITUTE
Entity Type:Organization
Organization Name:COMMUNITY SERVICES INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC MENTORING
Authorized Official - Prefix:
Authorized Official - First Name:ALCIDNO
Authorized Official - Middle Name:FONTES
Authorized Official - Last Name:MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-318-8985
Mailing Address - Street 1:1100 WASHINGTON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5520
Mailing Address - Country:US
Mailing Address - Phone:617-325-2993
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON ST STE 206
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5520
Practice Address - Country:US
Practice Address - Phone:617-325-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health