Provider Demographics
NPI:1174670442
Name:TOWN OF ARLINGTON
Entity Type:Organization
Organization Name:TOWN OF ARLINGTON
Other - Org Name:ARLINGTON YOUTH CONSULTATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF YOUTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-316-3251
Mailing Address - Street 1:730 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4906
Mailing Address - Country:US
Mailing Address - Phone:781-316-3255
Mailing Address - Fax:781-316-3261
Practice Address - Street 1:670 MASSACHUSETTS AVE # R
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5003
Practice Address - Country:US
Practice Address - Phone:781-316-3255
Practice Address - Fax:781-316-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305654Medicaid