1861611592 NPI number — COUNSELING & PSYCHOTHERAPY CENTER OF GREATER BOSTON, INC.

Table of content: (NPI 1861611592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861611592 NPI number — COUNSELING & PSYCHOTHERAPY CENTER OF GREATER BOSTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING & PSYCHOTHERAPY CENTER OF GREATER BOSTON, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE COUNSELING & PSYCHOTHERAPY CENTER, INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861611592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
687 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02494-2232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-455-8726
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
687 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-455-8726
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
APP
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
DIRECTOR OF OPERATION
Authorized Official Telephone Number:
800-455-8726

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  ISW01363 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: MA100144 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 153410000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431882600 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: TC18547 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1022840 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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