Healthcare Provider Details

I. General information

NPI: 1376328237
Provider Name (Legal Business Name): CDPH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SHATTUCK RD STE 220
ANDOVER MA
01810-2456
US

IV. Provider business mailing address

6 ELLSWORTH RD
ANDOVER MA
01810-4256
US

V. Phone/Fax

Practice location:
  • Phone: 978-494-4889
  • Fax:
Mailing address:
  • Phone: 978-335-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHANDLER DIFFILY
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 978-335-5164