Provider Demographics
NPI:1255402806
Name:VOLUNTEERS OF AMERICA OF MASSACHUSETTS INC
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA OF MASSACHUSETTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-822-4027
Mailing Address - Street 1:441 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1831
Mailing Address - Country:US
Mailing Address - Phone:508-822-4027
Mailing Address - Fax:508-822-8257
Practice Address - Street 1:5 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3206
Practice Address - Country:US
Practice Address - Phone:508-822-4027
Practice Address - Fax:508-822-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4372261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000008470OtherBOSTON MEDICAL CENTER HEA
1019410OtherBEACON HEALTH PLAN
715705000OtherMAGELLAN BEHAVIORAL HEALT
MAM18425OtherBCBSMA
MA613673OtherTUFTS
MA1310399Medicaid
MAM20075Medicare ID - Type Unspecified