Provider Demographics
NPI:1649390238
Name:COMMONWEALTH OF MASSACHUSETTS-DMH
Entity Type:Organization
Organization Name:COMMONWEALTH OF MASSACHUSETTS-DMH
Other - Org Name:METRO SUBURBAN AREA OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-616-2181
Mailing Address - Street 1:288 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2633
Mailing Address - Country:US
Mailing Address - Phone:508-616-2181
Mailing Address - Fax:
Practice Address - Street 1:288 LYMAN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2633
Practice Address - Country:US
Practice Address - Phone:508-616-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1802631Medicaid