Basic Information
| Provider Information | |||||||||
| NPI: | 1518499219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR HUMAN DEVELOPMENT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071104 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 367 PINE ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011051930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137371426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2017 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | GOODWIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4137336624 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 4168 | MA | Y | Agencies | Community/Behavioral Health |
No ID Information.