Provider Demographics
NPI:1942543731
Name:ADOLESCENT CONSULTATION SERVICES
Entity Type:Organization
Organization Name:ADOLESCENT CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-494-0135
Mailing Address - Street 1:189 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1206
Mailing Address - Country:US
Mailing Address - Phone:617-494-0135
Mailing Address - Fax:617-494-0136
Practice Address - Street 1:189 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1206
Practice Address - Country:US
Practice Address - Phone:617-494-0135
Practice Address - Fax:617-494-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health