MEDICARE: CBTEAM LLC

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

General Provider Information

NPI Number	:	1669074621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBTEAM LLC

Provider Business Mailing Address
First Line	:	81 HARTWELL AVE STE 310
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-3160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 HARTWELL AVENUE
Second Line	:	SUITE 310
City	:	LEXINGTON
State	:	MA
Zip	:	02421-3160
Country	:	US
Telephone Number	:	706-296-9661
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JASON ELIAS
Credential	:	PHD
Telephone Number	:	706-296-9661

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	04/30/2024

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Directions to “CBTEAM LLC ” Practice Location

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