Provider Demographics
NPI:1497870943
Name:COMMONWEALTH OF MASSACHUSETTS
Entity Type:Organization
Organization Name:COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:DEPARTMENT OF MENTAL HEALTH - NORTHEAST AREA OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTIGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-863-5012
Mailing Address - Street 1:365 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1950
Mailing Address - Country:US
Mailing Address - Phone:978-863-5012
Mailing Address - Fax:
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:978-863-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1802658Medicaid