Healthcare Provider Details

I. General information

NPI: 1770921777
Provider Name (Legal Business Name): URBANO PSYCHOLOGICAL & WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TREMONT ST STE 205-208
BOSTON MA
02108-5004
US

IV. Provider business mailing address

101 TREMONT ST SUITE 205-208
BOSTON MA
02108-5004
US

V. Phone/Fax

Practice location:
  • Phone: 617-410-6540
  • Fax:
Mailing address:
  • Phone: 617-410-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9583
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number9583
License Number StateMA

VIII. Authorized Official

Name: DR. ALESSANDRA URBANO
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 617-410-6540