Provider Demographics
NPI:1205965423
Name:CENTER FOR LIFESPAN DEVELOPMENT
Entity type:Organization
Organization Name:CENTER FOR LIFESPAN DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONCATA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-969-7891
Mailing Address - Street 1:91 WYMAN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1529
Mailing Address - Country:US
Mailing Address - Phone:617-969-7891
Mailing Address - Fax:
Practice Address - Street 1:91 WYMAN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1529
Practice Address - Country:US
Practice Address - Phone:617-969-7891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty