Basic Information
| Provider Information | |||||||||
| NPI: | 1801377544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR COUNSELING INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80471 | ||||||||
| Address2: | |||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021800005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7744540581 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021802420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7744540581 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7744540581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.ED., LMHC, CADC-II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9037 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.