Provider Demographics
NPI:1972817096
Name:FAMILIAS PARA EL PROGRESSO Y CAMBIO
Entity type:Organization
Organization Name:FAMILIAS PARA EL PROGRESSO Y CAMBIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTELL
Authorized Official - Middle Name:COFFY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:857-756-5682
Mailing Address - Street 1:54 RUTHVEN ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1611
Mailing Address - Country:US
Mailing Address - Phone:857-756-5682
Mailing Address - Fax:
Practice Address - Street 1:54 RUTHVEN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1611
Practice Address - Country:US
Practice Address - Phone:857-756-5682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health