Healthcare Provider Details

I. General information

NPI: 1952211492
Provider Name (Legal Business Name): CLERESTORY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

675 VFW PKWY STE 270
CHESTNUT HILL MA
02467-3656
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-5324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY SORG
Title or Position: OWNER
Credential: MD
Phone: 617-855-5324