Provider Demographics
NPI:1730302829
Name:DEPARTMENT OF DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF DEVELOPMENTAL SERVICES
Other - Org Name:FRANKLIN - HAMPSHIRE AREA OFFICE CM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C F O
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAILLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-624-7814
Mailing Address - Street 1:500 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2439
Mailing Address - Country:US
Mailing Address - Phone:617-624-7870
Mailing Address - Fax:
Practice Address - Street 1:FRANKLIN - HAMPSHIRE CM
Practice Address - Street 2:1 ROUNDHOUSE PLAZA
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-4948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1813188Medicaid