Healthcare Provider Details

I. General information

NPI: 1851055784
Provider Name (Legal Business Name): CAMBRIDGE PSYCHIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 05/09/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 WASHBURN AVE
CAMBRIDGE MA
02140-1128
US

IV. Provider business mailing address

54 WASHBURN AVE
CAMBRIDGE MA
02140-1128
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-0941
  • Fax: 617-876-9760
Mailing address:
  • Phone: 617-864-0941
  • Fax: 617-876-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY R HOULE
Title or Position: TREASURER
Credential:
Phone: 617-864-0941