Provider Demographics
NPI:1942359674
Name:RIVERSIDE COMMUNITY CARE
Entity Type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:617-969-8200
Mailing Address - Street 1:1244 CHESTNUT ST
Mailing Address - Street 2:NA
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1418
Mailing Address - Country:US
Mailing Address - Phone:617-969-8200
Mailing Address - Fax:617-928-0459
Practice Address - Street 1:1244 CHESTNUT ST
Practice Address - Street 2:NA
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1418
Practice Address - Country:US
Practice Address - Phone:617-969-8200
Practice Address - Fax:617-928-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA496261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center