Lake Avenue Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

LAKE AVENUE RECOVERY, LLC

Practice address

425 Lake Ave N
Worcester, MA 01605-2047

Phone

(508) 794-4400

NPI assigned

Jan 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Maroney, MS, LADC1NPI 1790813400

Title

Executive Director

Phone

(508) 826-6182

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John J Maroney, LADC1

  • Professional Counselor
  • Woburn, MA
  • NPI 1790813400
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1831739739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 BRENTWOOD DRIVE",
            "city": "HOLDEN",
            "state": "MA",
            "postal_code": "015201932",
            "telephone_number": "508-826-6182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052047",
            "telephone_number": "508-794-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "213 School Street",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Gardner",
            "state": "MA",
            "postal_code": "01440",
            "country_code": "US",
            "telephone_number": "508-826-6182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE AVENUE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-09",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "MARONEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-826-6182",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LADC1"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yushuan Lai, M.D., PH.D.
• Douglas W Laidlaw, M.D.
• Jenna Laidley, MD
• Ruth Ninoska Lainez Urrutia, MD
• Samantha Rose Laitinen
• Alisha Lakhani, MD, MPH
• Amber Elizabeth Lakota
• Srividhya Lakshmanan, M.D.
• Tasneem Kassam Lalani, MD
• Benjamin Laliberte, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Worcester, MA
• Providers in Worcester, MA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.