Healthcare Provider Details

I. General information

NPI: 1073015194
Provider Name (Legal Business Name): GREATER BOSTON WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST BLDG 1
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN ST BLDG 1
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-383-7804
  • Fax: 888-857-0151
Mailing address:
  • Phone: 617-383-7804
  • Fax: 888-857-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. IRENE PIRYATINSKY
Title or Position: OWNER
Credential: PHD
Phone: 617-383-7894