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Organization
STREETTHERAPY,LLC
Active
Organization
STREETTHERAPY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA NELLE STREET LMHC (THERAPIST)
(617) 855-2742
Entity
Organization
Contact information
Practice address
TRIAD ADOLESCENT SERVICES, 363 MASS. AVE., SUITE204, LEXINGTON, MA 02421
(617) 855-2742
Mailing address
96 WARREN ST, MEDFORD, MA 02155-2235
(617) 855-2742
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376752345
MCLEAN HOSPITAL
MA
Enumeration date
11/20/2019
Last updated
11/20/2019
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