Provider Demographics
NPI:1598968752
Name:COMMUNITY RESOURCES FOR JUSTICE
Entity Type:Organization
Organization Name:COMMUNITY RESOURCES FOR JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNARUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-482-2520
Mailing Address - Street 1:355 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3332
Mailing Address - Country:US
Mailing Address - Phone:617-482-2520
Mailing Address - Fax:617-262-8054
Practice Address - Street 1:75 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3802
Practice Address - Country:US
Practice Address - Phone:203-576-6924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00101Y00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0002398Medicare UPIN