Provider Demographics
NPI:1023385556
Name:LANGUAGE AND COGNITIVE DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:LANGUAGE AND COGNITIVE DEVELOPMENT CENTER
Other - Org Name:LCDC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER (OPERATIONS)
Authorized Official - Prefix:MR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:BARAK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BA,BS
Authorized Official - Phone:617-921-8159
Mailing Address - Street 1:154 WELLS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3347
Mailing Address - Country:US
Mailing Address - Phone:617-965-0045
Mailing Address - Fax:
Practice Address - Street 1:154 WELLS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-3347
Practice Address - Country:US
Practice Address - Phone:617-965-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency