Provider Demographics
NPI:1255450631
Name:COMMUNITY SERVICES INSTITUTE, INC.
Entity type:Organization
Organization Name:COMMUNITY SERVICES INSTITUTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BONZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-739-5572
Mailing Address - Street 1:1695 MAIN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1348
Mailing Address - Country:US
Mailing Address - Phone:413-739-5572
Mailing Address - Fax:413-739-9972
Practice Address - Street 1:1695 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1348
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:413-739-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4436251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004980Medicaid
MA110027920BMedicaid
MA1303856Medicaid
MA997648Medicaid
MAM18747OtherBCBSMA ID
MA000000020081Medicaid
MA110027920AMedicaid
MA1307541Medicaid
MAY10271Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MA1307541Medicaid