Healthcare Provider Details

I. General information

NPI: 1104248723
Provider Name (Legal Business Name): ABAC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 BLUE HILL AVE
BOSTON MA
02124-2828
US

IV. Provider business mailing address

995 BLUE HILL AVE
BOSTON MA
02124-2828
US

V. Phone/Fax

Practice location:
  • Phone: 617-822-0829
  • Fax: 617-825-7804
Mailing address:
  • Phone: 617-822-0829
  • Fax: 617-825-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. TERRI ANN BETTS
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D
Phone: 617-822-0829