Basic Information
| Provider Information | |||||||||
| NPI: | 1851788103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CEREBRAL PALSY ASSOCIATION OF EASTERN MASSACHUSETTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 JOHNSON ST | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019024001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815932727 | ||||||||
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| Address1: | 103 JOHNSON ST | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019024001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815932727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | RUSSELL | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EI PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7815932727 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.