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General NPI Number Information
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NPI Number | 1801377544
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Entity Type | Organization
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Legal Business Name | CEDAR COUNSELING INC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 25 CEDAR AVE
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City | STONEHAM
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State | MA
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Zip | 02180-2420
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Country | US
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Telephone | 774-454-0581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80471
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City | STONEHAM
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State | MA
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Zip | 02180-0005
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Country | US
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Telephone | 774-454-0581
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MR. DANIEL A SULLIVAN JR.
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Credential | M.ED., LMHC, CADC-II
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Telephone | 774-454-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9037
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License Number State | MA
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