Provider Demographics
NPI:1942756077
Name:COMMONWEALTH CARE ALLIANCE
Entity type:Organization
Organization Name:COMMONWEALTH CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CYSZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, MPH, MSN, CHPN
Authorized Official - Phone:413-887-5130
Mailing Address - Street 1:101 WASON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01038-9753
Practice Address - Country:US
Practice Address - Phone:413-244-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN264992302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization