Healthcare Provider Details

I. General information

NPI: 1013892025
Provider Name (Legal Business Name): CENTRAL SQUARE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MASSACHUSETTS AVE STE 12
CAMBRIDGE MA
02139-3309
US

IV. Provider business mailing address

675 MASSACHUSETTS AVE
CAMBRIDGE MA
02139-3309
US

V. Phone/Fax

Practice location:
  • Phone: 978-843-0600
  • Fax:
Mailing address:
  • Phone: 617-812-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRYSTIN QUINN
Title or Position: VP OPERATIONS
Credential:
Phone: 617-812-1553