MEDICARE: CAMBRIDGE EATING DISORDER CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6214	MA
2	103TC2200X	Clinical Child & Adolescent Psychologist	6214	MA
3	103TF0000X	Family Psychologist	6214	MA
4	103TP2701X	Group Psychotherapy Psychologist	6214	MA
5	1041C0700X	Clinical Social Worker	6214	MA
6	323P00000X	Psychiatric Residential Treatment Facility	MB-PRF-914	MA

General Provider Information

NPI Number	:	1518081108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIDGE EATING DISORDER CENTER

Provider Business Mailing Address
First Line	:	3 BOW ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5103
Country	:	US
Telephone Number	:	617-547-2255
Fax Number	:	617-547-0003

Provider Business Practice Location Address
First Line	:	3 BOW ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5103
Country	:	US
Telephone Number	:	617-547-2255
Fax Number	:	617-547-0003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SEDA EBRAHIMI-KESHISHIAN
Credential	:	PH.D.
Telephone Number	:	617-547-2255

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	11/14/2014

Similar Medicare Providers

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