Provider Demographics
NPI:1982386447
Name:INNOVATIVE SOCIAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE SOCIAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSSA, DBH, LICSW
Authorized Official - Phone:440-991-6623
Mailing Address - Street 1:92 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1425
Mailing Address - Country:US
Mailing Address - Phone:617-971-8332
Mailing Address - Fax:
Practice Address - Street 1:92 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1425
Practice Address - Country:US
Practice Address - Phone:617-971-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health