Provider Demographics
NPI:1396620266
Name:INTEGRATED CENTER FOR CHILD DEVELOPMENT COMMUNITY
Entity type:Organization
Organization Name:INTEGRATED CENTER FOR CHILD DEVELOPMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-619-1516
Mailing Address - Street 1:340 TURNPIKE ST STE 1-3A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2700
Mailing Address - Country:US
Mailing Address - Phone:781-619-1516
Mailing Address - Fax:781-619-1509
Practice Address - Street 1:109 OAK ST STE G10
Practice Address - Street 2:
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:781-619-1500
Practice Address - Fax:781-619-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty