Healthcare Provider Details

I. General information

NPI: 1598821480
Provider Name (Legal Business Name): TANYA TERRY GURIAN APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOSTON INSTITUTE FOR PSYCHOTHERAPY 1415 BEACON ST
BROOKLINE MA
02446
US

IV. Provider business mailing address

328 MASON TERR
BROOKLINE MA
02446-2779
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax:
Mailing address:
  • Phone: 617-935-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number105352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: