STREETTHERAPY,LLC


Address: Triad Adolescent Services, 363 Mass. Ave., Suite204, Lexington, MA 02421
Phone: 6178552742

STREETTHERAPY,LLC (NPI# 1972149300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1972149300
Entity Type Organization
Organization Name STREETTHERAPY,LLC
Practice Address Triad Adolescent Services
363 Mass. Ave., Suite204
Lexington
MA 02421
Mailing Address 96 Warren St
Medford
MA 02155-2235
Practice Telephone 6178552742
Mailing Telephone 6178552742
Enumeration Date 2019-11-20
Last Update Date 2019-11-20
Authorized Official Name LAURA NELLE STREET (THERAPIST)
Authorized Official Telephone 6178552742
Authorized Official Credential LMHC
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YM0800X Counselor
Specialization: Mental Health
Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MA MCLEAN HOSPITAL 1376752345 01

Office Location

Street Address TRIAD ADOLESCENT SERVICES
363 MASS. AVE., SUITE204
City LEXINGTON
State MA
Zip Code 02421

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NPI Name Taxonomy Address Enumeration
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1902390388 Erika Yaneth Valek Counselor 125 Hartwell Avenue, Lexington, MA 02421 2018-06-19
1366743668 Elizabeth Ann Murphy Social Worker 17 Stedman Rd, Lexington, MA 02421 2010-11-03
1003045063 Nils Becker Pathology 1 Cranberry Hill Ste 303, Lexington, MA 02421 2009-07-10
1780829556 Lynn Joan Meltzer Psychologist Institute for Learning and Development, 4 Militia Drive, Lexington, MA 02421 2008-12-09
1962666511 Kristin Stanley Rullo Optometrist 21 Worthen Road, Lexington, MA 02421 2008-07-14
1861660201 Jillian S Imagire Radiology Concert Pharmaceuticals, 99 Hayden Ave, Suite 100, Lexington, MA 02421 2008-02-20
1144498049 Lexington Dental Associates Dentist 271 Lincoln Street, Suite 2, Lexington, MA 02421 2008-02-13
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Taxonomy Information

Taxonomy Code 101YM0800X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Mental Health

Taxonomy Definition

Definition to come...

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Competitor

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City LEXINGTON
Zip Code 02421

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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