Provider Demographics
NPI:1235255597
Name:COMMONWEALTH OF MASSACHUSETTS
Entity Type:Organization
Organization Name:COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:DEPARTMENT OF MENTAL HEALTH - METRO BOSTON AREA OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-626-9238
Mailing Address - Street 1:85 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2340
Mailing Address - Country:US
Mailing Address - Phone:617-626-9238
Mailing Address - Fax:
Practice Address - Street 1:85 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2340
Practice Address - Country:US
Practice Address - Phone:617-626-9238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1802615Medicaid