Provider Demographics
NPI:1720401979
Name:INTEGRATED CENTER FOR CHILD DEVELOPMENT
Entity Type:Organization
Organization Name:INTEGRATED CENTER FOR CHILD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPIES
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:781-619-1581
Mailing Address - Street 1:340 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2700
Mailing Address - Country:US
Mailing Address - Phone:781-619-1500
Mailing Address - Fax:617-527-0640
Practice Address - Street 1:340 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2700
Practice Address - Country:US
Practice Address - Phone:781-619-1500
Practice Address - Fax:617-527-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty