Provider Demographics
NPI:1720203185
Name:BAYSTATE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:BAYSTATE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-GRANITE HOUSE
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED,LMHC
Authorized Official - Phone:617-479-4043
Mailing Address - Street 1:40 CERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1311
Mailing Address - Country:US
Mailing Address - Phone:617-901-5219
Mailing Address - Fax:
Practice Address - Street 1:12 TEMPLE ST
Practice Address - Street 2:BAYSTATE COMMUNITY SERVICES
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-479-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health