| Streettherapy,llc | |
|
Triad Adolescent Services 363 Mass. Ave., Suite204 Lexington MA 02421 | |
| (617) 855-2742 | |
| Not Available |
| Full Name | Streettherapy,llc |
|---|---|
| Speciality | Counselor |
| Location | Triad Adolescent Services, Lexington, Massachusetts |
| Authorized Official Name and Position | Laura Nelle Street (THERAPIST) |
| Authorized Official Contact | 6178552742 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Streettherapy,llc 96 Warren St Medford MA 02155-2235 Ph: (617) 855-2742 | Streettherapy,llc Triad Adolescent Services 363 Mass. Ave., Suite204 Lexington MA 02421 Ph: (617) 855-2742 |
| NPI Number | 1972149300 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 11/20/2019 |
| Medicare PECOS PAC ID | 5395184048 |
|---|---|
| Medicare Enrollment ID | O20240415002996 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972149300 | NPI | - | NPPES |
| 1376752345 | Other | MA | MCLEAN HOSPITAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Laura N. Street |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376752345 PECOS PAC ID: 2668811316 Enrollment ID: I20240415002976 |
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