Basic Information
| Provider Information | |||||||||
| NPI: | 1912099219 | ||||||||
| 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 | ||||||||
| TelephoneNumber: | 4137336624 | ||||||||
| FaxNumber: | 4134392109 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137336624 | ||||||||
| FaxNumber: | 4134392109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOODWIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 4134292247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 4168 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 101YM0800X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103TC2200X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 106H00000X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 251S00000X | 4538 | MA | N | Agencies | Community/Behavioral Health | 252Y00000X | MA | N | Agencies | Early Intervention Provider Agency | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 101YA0400X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 261QA0600X | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 251S00000X | 4168 | MA | Y | Agencies | Community/Behavioral Health |
No ID Information.