Provider Demographics
NPI:1922151802
Name:COMMONWEALTH OF MASS. - ERICH LINDEMANN MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH OF MASS. - ERICH LINDEMANN MENTAL HEALTH CENTER
Other - Org Name:METRO BOSTON MENTAL HEALTH UNITS AT LINDEMANN
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-626-8558
Mailing Address - Street 1:25 STANIFORD ST
Mailing Address - Street 2:PLAZA LEVEL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2503
Mailing Address - Country:US
Mailing Address - Phone:617-626-8558
Mailing Address - Fax:617-626-8669
Practice Address - Street 1:25 STANIFORD ST
Practice Address - Street 2:PLAZA LEVEL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2503
Practice Address - Country:US
Practice Address - Phone:617-626-8558
Practice Address - Fax:617-626-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1103199Medicaid
MA224037Medicare Oscar/Certification
MA1103199Medicaid