Provider Demographics
NPI:1013549658
Name:REGISTER THERAPEUTIC ALLIANCE
Entity Type:Organization
Organization Name:REGISTER THERAPEUTIC ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:203-918-0000
Mailing Address - Street 1:89 CHARLES RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1442
Mailing Address - Country:US
Mailing Address - Phone:781-444-4979
Mailing Address - Fax:339-777-5923
Practice Address - Street 1:992 GREAT PLAIN AVE STE 25
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2524
Practice Address - Country:US
Practice Address - Phone:203-918-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty