Provider Demographics
NPI:1841421245
Name:CAMBRIDGE SEST ED
Entity Type:Organization
Organization Name:CAMBRIDGE SEST ED
Other - Org Name:CSEST ED
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:PHD
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:617-665-1000
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:617-414-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY PSYCHIATRY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health