Provider Demographics
NPI:1205365509
Name:MARLBOROUGH COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:MARLBOROUGH COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:CLEARPATH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-658-0880
Mailing Address - Street 1:40 MECHANIC ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4425
Mailing Address - Country:US
Mailing Address - Phone:508-658-0880
Mailing Address - Fax:508-597-7772
Practice Address - Street 1:40 MECHANIC ST STE 300
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4425
Practice Address - Country:US
Practice Address - Phone:508-658-0880
Practice Address - Fax:508-597-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty