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General NPI Number Information
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NPI Number | 1326053786
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Entity Type | Organization
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Legal Business Name | MELROSE-WAKEFIELD BEHAVORIAL HEALTH CENTER, P.C.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 800 W CUMMINGS PARK SUITE 4700
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City | WOBURN
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State | MA
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Zip | 01801-6372
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Country | US
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Telephone | 781-224-0661
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Fax | 781-224-1993
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Provider Business Mailing Address
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Address Line | 800 W CUMMINGS PARK SUITE 4700
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City | WOBURN
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State | MA
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Zip | 01801-6372
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Country | US
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Telephone | 781-224-0661
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Fax | 781-224-1993
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LALITH M. TISSERA
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Credential |
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Telephone | 781-224-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 81635
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License Number State | MA
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