National Provider Identifier Database

WAYSIDE YOUTH FAMILY SUPPORT NETWORK
Voluntary or Charitable


Contact Information

WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
118 CENTRAL ST
WALTHAM, MA02453-5465
Phone: 781-891-0556
Fax:
Website:
Specialty Taxonomy Code
* Voluntary or Charitable 251V00000X

* Indicates primary specialty

NPI Profile & details for WAYSIDE YOUTH & FAMILY SUPPORT NETWORK

NPI Number 1669690467
Legal business name
LBN
WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
Authorized official ERIC MASI - (CEO)
Entity Organization
Organization subpart No
Enumeration date 04/24/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • MA License #: 0592
  • MA Medicaid: 1803689
  • MA Other: EI0019 BLUE CROSS BLE SHIELD
  • MA Other: 8710897 CIGNA
  • MA Other: 6119935 HARVARD PILGRIM

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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