| Sport Development Services Inc. | |
|
19 Boyden St Dorchester Center MA 02124-3212 | |
| (781) 244-0894 | |
| Not Available |
| Full Name | Sport Development Services Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 19 Boyden St, Dorchester Center, Massachusetts |
| Authorized Official Name and Position | Floyd A Williams-agnew (CEO/PRESIDENT) |
| Authorized Official Contact | 7812440894 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sport Development Services Inc. 300 Main St Unit 121 North Easton MA 02356-0610 Ph: () - | Sport Development Services Inc. 19 Boyden St Dorchester Center MA 02124-3212 Ph: (781) 244-0894 |
| NPI Number | 1811681802 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 06/05/2023 |
| Certification Date | 06/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811681802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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