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An official website of the MassHealth Community Case Management (CCM) program
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CCM
Nurse Directory
Home
Contact
Nurse Registration
Note: Fields marked with a red
*
are required.
Applicant Information
Which type of CSN Provider are you?
If you work as an Independent Nurse and an Agency Nurse you can register as either one. You will be allowed to enter in a profile for both.
Agency Nurse
Independent Nurse
First Name
Last Name
Street Address
City
State
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
Home Phone Number
Cell Phone Number
MassHealth Provider ID and Location
State License Number
Agency
---- Select an agency ----
Is your CORI up-to-date and in good standing?
Yes
No
Is your license active and in good standing with the State Board of Nursing?
Yes
No
Preferred initial contact method
E-mail
Phone
Cell phone
Text message
Email
Password
Confirm password
Password must be at least 8 characters long.
Passwords must have at least one non letter or digit character (!,#,$,%,^,?,*,_,-).
Passwords must have at least one digit ('0'-'9').
Passwords must have at least one uppercase ('A'-'Z').
Passwords must have at least one lowercase ('a'-'z').
Make a selection
Please select a city from the list bellow
City Selection