Healthcare Provider Details

I. General information

NPI: 1437487402
Provider Name (Legal Business Name): TRINITY BOSTON FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CLARENDON ST
BOSTON MA
02116-3722
US

IV. Provider business mailing address

206 CLARENDON ST
BOSTON MA
02116-3722
US

V. Phone/Fax

Practice location:
  • Phone: 617-536-0944
  • Fax: 617-536-8916
Mailing address:
  • Phone: 617-536-0944
  • Fax: 617-536-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LOUISE BURNHAM PACKARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-536-0944