Provider Demographics
NPI:1972357333
Name:CEDAR STREET COLLABORATIVE
Entity Type:Organization
Organization Name:CEDAR STREET COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOGAN-RIGG
Authorized Official - Suffix:V
Authorized Official - Credentials:MPH, LICSW
Authorized Official - Phone:781-228-8934
Mailing Address - Street 1:212 CEDAR ST # 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3521
Mailing Address - Country:US
Mailing Address - Phone:617-902-0349
Mailing Address - Fax:
Practice Address - Street 1:212 CEDAR ST # 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3521
Practice Address - Country:US
Practice Address - Phone:617-902-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty