Provider Demographics
NPI:1821380106
Name:MELROSE WAKEFIELD BEHAVIORAL HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:MELROSE WAKEFIELD BEHAVIORAL HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LALILTH
Authorized Official - Middle Name:
Authorized Official - Last Name:TISSERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-224-3607
Mailing Address - Street 1:11 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2304
Practice Address - Country:US
Practice Address - Phone:781-224-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115832251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health