1881844975 NPI number — BOSTON EVENING THERAPY ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881844975 NPI number — BOSTON EVENING THERAPY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON EVENING THERAPY ASSOCIATES, LLC
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:
Provider Other Organization Name Type Code:
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:
1881844975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 BEACON ST
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02459-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-738-1480
Provider Business Mailing Address Fax Number:
617-738-1488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 KENT ST
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-7959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-738-1480
Provider Business Practice Location Address Fax Number:
617-738-1488
Provider Enumeration Date:
09/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
AARON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
617-738-1480

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  1032829 , 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)





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