Provider Demographics
NPI:1578817169
Name:CENTER FOR HUMAN DEVELOPEMENT
Entity Type:Organization
Organization Name:CENTER FOR HUMAN DEVELOPEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOVIK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-439-1260
Mailing Address - Street 1:622 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4104
Mailing Address - Country:US
Mailing Address - Phone:413-654-1600
Mailing Address - Fax:413-654-1606
Practice Address - Street 1:622 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4104
Practice Address - Country:US
Practice Address - Phone:413-654-1600
Practice Address - Fax:413-654-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QM0801X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service