Provider Demographics
NPI:1285023655
Name:JUSTICE RESOURCE INSTITUTE
Entity Type:Organization
Organization Name:JUSTICE RESOURCE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC MENTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JARRELL
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-987-5977
Mailing Address - Street 1:3 PICKERING AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2225
Mailing Address - Country:US
Mailing Address - Phone:617-987-5977
Mailing Address - Fax:
Practice Address - Street 1:3 PICKERING AVENUE # 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2225
Practice Address - Country:US
Practice Address - Phone:617-987-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health