Provider Demographics
NPI:1225327182
Name:RED ROAD PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:RED ROAD PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-767-0008
Mailing Address - Street 1:141 MEMORIAL PKWY
Mailing Address - Street 2:PMB #190
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4511
Mailing Address - Country:US
Mailing Address - Phone:781-767-0008
Mailing Address - Fax:781-390-3108
Practice Address - Street 1:1191 N MAIN ST
Practice Address - Street 2:SUITE #204
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2135
Practice Address - Country:US
Practice Address - Phone:781-767-0008
Practice Address - Fax:781-390-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty