Healthcare Provider Details

I. General information

NPI: 1215770292
Provider Name (Legal Business Name): BOSTON THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 DEVONSHIRE ST STE 502
BOSTON MA
02110-1407
US

IV. Provider business mailing address

185 DEVONSHIRE ST STE 502
BOSTON MA
02110-1407
US

V. Phone/Fax

Practice location:
  • Phone: 617-435-0202
  • Fax:
Mailing address:
  • Phone: 617-435-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TOMASZ VAV
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 617-435-0202