Provider Demographics
NPI:1114409489
Name:CLINICAL ALLIANCES SERVICES, LLC
Entity Type:Organization
Organization Name:CLINICAL ALLIANCES SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-307-4470
Mailing Address - Street 1:10 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2322
Mailing Address - Country:US
Mailing Address - Phone:617-307-4470
Mailing Address - Fax:617-849-5863
Practice Address - Street 1:10 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2322
Practice Address - Country:US
Practice Address - Phone:617-230-3002
Practice Address - Fax:617-849-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9008103T00000X
251S00000X, 261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1912113564OtherNPI