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General NPI Number Information
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NPI Number | 1396554903
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Entity Type | Organization
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Legal Business Name | CLINICAL MAJIC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 160 ALEWIFE BROOK PKWY # 1115
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1102
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Country | US
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Telephone | 508-287-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 160 ALEWIFE BROOK PKWY # 1115
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY PAPASODERO
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Credential | LMHC
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Telephone | 508-287-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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