MEDICARE: COMPOS MENTIS NEUROPSYCH PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1821934589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPOS MENTIS NEUROPSYCH PLLC

Provider Business Mailing Address
First Line	:	8401 MAYLAND DR STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	617-997-1691
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 COURTFIELD AVE
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-3204
Country	:	US
Telephone Number	:	617-997-1691
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS CHARLES BOSTON
Credential	:	PSY.D.
Telephone Number	:	617-997-1691

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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