Provider Demographics
NPI:1659497253
Name:THE HOME FOR LITTLE WANDERERS
Entity Type:Organization
Organization Name:THE HOME FOR LITTLE WANDERERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HUFF-LARMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:617-469-8692
Mailing Address - Street 1:6 GLORIA RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4309
Mailing Address - Country:US
Mailing Address - Phone:781-963-3373
Mailing Address - Fax:
Practice Address - Street 1:780 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3908
Practice Address - Country:US
Practice Address - Phone:617-469-8692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health