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General NPI Number Information
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NPI Number | 1316565005
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Entity Type | Organization
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Legal Business Name | MDS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 186 ALEWIFE BROOK PKWY # 1019
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1121
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Country | US
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Telephone | 202-615-7420
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Fax |
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Provider Business Mailing Address
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Address Line | 186 ALEWIFE BROOK PKWY # 1019
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1121
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Country | US
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Telephone | 202-615-7420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE DE SEDAS
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Credential |
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Telephone | 202-615-7420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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