Healthcare Provider Details

I. General information

NPI: 1760274740
Provider Name (Legal Business Name): BOSTON THERAPY COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E 8TH ST APT 2
BOSTON MA
02127-3444
US

IV. Provider business mailing address

728 E 8TH ST APT 2
BOSTON MA
02127-3444
US

V. Phone/Fax

Practice location:
  • Phone: 410-598-4877
  • Fax:
Mailing address:
  • Phone: 617-257-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY GAVIN
Title or Position: CO-OWNER
Credential:
Phone: 617-257-2237