Provider Demographics
NPI:1316368749
Name:TRIAD ADOLESCENT SERVICES
Entity Type:Organization
Organization Name:TRIAD ADOLESCENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GALEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-290-9432
Mailing Address - Street 1:363 MASS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-864-4814
Mailing Address - Fax:
Practice Address - Street 1:363 MASS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-864-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2353101YA0400X
MA9159103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty