Provider Demographics
NPI:1467700070
Name:THE COUNSELING CENTER FOR CHILD DEVELOPMENT INC
Entity Type:Organization
Organization Name:THE COUNSELING CENTER FOR CHILD DEVELOPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-393-5151
Mailing Address - Street 1:10 CABOT RD
Mailing Address - Street 2:101
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD
Practice Address - Street 2:101
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5177
Practice Address - Country:US
Practice Address - Phone:781-393-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management