Provider Demographics
NPI: | 1912987181 |
---|---|
Name: | CHILD AND FAMILY PSYCHOLOGICAL SERVICES, PLLC |
Entity Type: | Organization |
Organization Name: | CHILD AND FAMILY PSYCHOLOGICAL SERVICES, PLLC |
Other - Org Name: | LIFESTANCE HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF LEGAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RYAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PARDO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 425-279-8500 |
Mailing Address - Street 1: | 169 LIBBEY PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | EAST WEYMOUTH |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02189-3101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-551-0999 |
Mailing Address - Fax: | 781-551-3396 |
Practice Address - Street 1: | 89 ACCESS RD |
Practice Address - Street 2: | SUITE 24 |
Practice Address - City: | NORWOOD |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02062 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-551-0999 |
Practice Address - Fax: | 781-551-3396 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-01-22 |
Last Update Date: | 2024-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
No | 247200000X | Technologists, Technicians & Other Technical Service Providers | Technician, Other | Group - Multi-Specialty | |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | J14630 | Medicare ID - Type Unspecified | |
MA | W10336 | Medicare ID - Type Unspecified |