22D2284243 CLIA NUMBER - COMMONWEALTH BEHAVIORAL HEALTH, LLC

Laboratory Demographics

  • CLIA Code: 22D2284243
  • Facility Name: COMMONWEALTH BEHAVIORAL HEALTH, LLC
  • Facility Address: 105 EASTERN AVE STE 216
    DEDHAM, MA
    ZIP 02026
  • Facility Phone: 617 529-8216
  • Facility Type: Other - OUTPATIENT BEHAVIORAL HEA
  • Facility Type: Waiver
  • Lab Director: JUSTIN R. CAMBRIA
  • NPI Number: 1992418099
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 22D2284243
LAB Type Other - OUTPATIENT BEHAVIORAL HEA
Facility Name COMMONWEALTH BEHAVIORAL HEALTH, LLC
Street 105 EASTERN AVE STE 216
City DEDHAM
State MA
ZIP 02026
Phone 617 529-8216
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2023
Certificate Expiration Date 6/19/2025
Facility Type Other - OUTPATIENT BEHAVIORAL HEA
Lab Director JUSTIN R. CAMBRIA

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This page was last updated on: 3/20/2025