Provider Demographics
NPI:1598047417
Name:CAMBRIDGE HEALTH ALLIANCE
Entity Type:Organization
Organization Name:CAMBRIDGE HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-665-1600
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2827
Practice Address - Country:US
Practice Address - Phone:617-591-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268151261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)