Provider Demographics
NPI:1851055784
Name:CAMBRIDGE PSYCHIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:CAMBRIDGE PSYCHIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-864-0941
Mailing Address - Street 1:54 WASHBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1128
Mailing Address - Country:US
Mailing Address - Phone:617-864-0941
Mailing Address - Fax:617-876-9760
Practice Address - Street 1:54 WASHBURN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1128
Practice Address - Country:US
Practice Address - Phone:617-864-0941
Practice Address - Fax:617-876-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty