Contacts
Board of Certification of Community Health Workers
Phone
The Details of Update your CHW Certificate information or request a duplicate
What you need for Update your CHW Certificate information or request a duplicate
If you are requesting changes online:
You will need your Online Licensing username and password. If you do not have an account yet, you may search for your records with your date of birth and SSN.
You cannot request a name change through the online portal. This must be done via mail.
If you are requesting changes through paper application, you need your:
-License number
-Social Security Number
-Date of birth
For a name change: You must return the original hard copy of your license and submit a copy of supporting documents. Supporting documents include:
-Marriage certificate
-Divorce decree
-Court documents
-Other documentation
Fees for Update your CHW Certificate information or request a duplicate
For duplicate licenses:
You must pay the duplicate license fee for each license you wish to have duplicated
There are no fees for address changes or name changes with renewal.
Pay by check or money order, payable to the Commonwealth of Massachusetts
Do NOT send cash or electronic funds transfers.
|
Name |
Fee |
Unit |
|
Duplicate license |
$17 |
Per license |
|
Name change with new license |
$27 |
Per license |
How to apply Update your CHW Certificate information or request a duplicate
Download and complete the application, found below
Attach all documentation and fees. Mail to:
Board of Certification of Community Health Workers
250 Washington Street
Boston, MA 02108
Please note: name changes must be submitted via mail with applicable attachments
For requesting address changes and/or duplicate licenses, you can login to our Online Licensing portal.
More info for Update your CHW Certificate information or request a duplicate
If you are requesting a name change and you have a current or expired license with another board within the Bureau, the requested name change will be effective for all boards
All addresses are subject to disclosure on request (MGL c. 4, s. 7)
MA Board of Certification of Community Health Workers
250 Washington Street
Boston, MA 02108