MEDICARE: PYRAMID BUILDERS ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		MA

General Provider Information

NPI Number	:	1164622551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PYRAMID BUILDERS ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1960 WASHINGTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-3219
Country	:	US
Telephone Number	:	617-516-0280
Fax Number	:	617-516-0281

Provider Business Practice Location Address
First Line	:	1960 WASHINGTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-3219
Country	:	US
Telephone Number	:	617-516-0280
Fax Number	:	617-516-0281

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	DR. OMAR G REID
Credential	:	PSY.D
Telephone Number	:	617-516-0280

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	12/17/2008

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