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General NPI Number Information
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NPI Number | 1114409489
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Entity Type | Organization
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Legal Business Name | CLINICAL ALLIANCES SERVICES, LLC
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 10 CONCORD AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2322
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Country | US
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Telephone | 617-230-3002
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Fax | 617-849-5863
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Provider Business Mailing Address
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Address Line | 10 CONCORD AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2322
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Country | US
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Telephone | 617-307-4470
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Fax | 617-849-5863
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. LISSA DUTRA
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Credential | PH.D.
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Telephone | 617-307-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 9008
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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