Healthcare Provider Details

I. General information

NPI: 1841168911
Provider Name (Legal Business Name): ORANGE DOOR COLLABORATIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 MASSACHUSETTS AVE STE 7
CAMBRIDGE MA
02139-3329
US

IV. Provider business mailing address

763 MASSACHUSETTS AVE STE 7
CAMBRIDGE MA
02139-3329
US

V. Phone/Fax

Practice location:
  • Phone: 508-507-7759
  • Fax: 617-977-2135
Mailing address:
  • Phone: 508-507-7759
  • Fax: 617-977-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAOMI TAMARA AZAR
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 617-209-9866