Provider Demographics
NPI:1679704662
Name:NORTH SUFFOLK CCS, CAMBRIDGE/SOMERVILLE
Entity Type:Organization
Organization Name:NORTH SUFFOLK CCS, CAMBRIDGE/SOMERVILLE
Other - Org Name:NS CCS, CAMBRIDGE/SOMERVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-4920
Mailing Address - Street 1:85 E NEWTON ST
Mailing Address - Street 2:M802
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2340
Mailing Address - Country:US
Mailing Address - Phone:617-591-4500
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:230 HIGHLAND AVE
Practice Address - Street 2:NS CCS
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1408
Practice Address - Country:US
Practice Address - Phone:617-591-4500
Practice Address - Fax:617-414-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERISTY PSYCHIATRY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health