| Community Support Program | |
|
125 Hartwell Ave Lexington MA 02421-3100 | |
| (781) 861-0890 | |
| Not Available |
| Full Name | Community Support Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 125 Hartwell Ave, Lexington, Massachusetts |
| Authorized Official Name and Position | Leona Walton (BILLING SUPPORT ANALYST) |
| Authorized Official Contact | 7818610890 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Support Program 125 Hartwell Ave Lexington MA 02421-3100 Ph: (781) 861-0890 | Community Support Program 125 Hartwell Ave Lexington MA 02421-3100 Ph: (781) 861-0890 |
| NPI Number | 1396435624 |
|---|---|
| Provider Enumeration Date | 05/10/2023 |
| Last Update Date | 05/10/2023 |
| Certification Date | 05/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396435624 | NPI | - | NPPES |
| 110027776 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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