=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619944105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMBRIDGE HEALTH ALLIANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 RAYMOND ST APT 2
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02140-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-492-1529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 RAYMOND STREET APT 2
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-492-1529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF PSYCHIATRIST
-----------------------------------------------------
Name | DR. LIOR GIVON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 617-665-2105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------