Provider Demographics
NPI:1093942914
Name:CENTRAL SQUARE THERAPY ASSOCIATES
Entity type:Organization
Organization Name:CENTRAL SQUARE THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMADO
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-592-6100
Mailing Address - Street 1:150 MARKET ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1529
Mailing Address - Country:US
Mailing Address - Phone:781-592-6100
Mailing Address - Fax:781-592-1093
Practice Address - Street 1:150 MARKET ST
Practice Address - Street 2:2ND FL
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1529
Practice Address - Country:US
Practice Address - Phone:781-592-6100
Practice Address - Fax:781-592-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD1600X, 261QM0801X
MA261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health