Healthcare Provider Details

I. General information

NPI: 1811927783
Provider Name (Legal Business Name): NATIONAL PSYCHIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KENT ST
BROOKLINE MA
02445-7901
US

IV. Provider business mailing address

59 TEMPLE PL SUITE 612
BOSTON MA
02111-1307
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-4640
  • Fax: 617-734-0994
Mailing address:
  • Phone: 617-264-9764
  • Fax: 617-264-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PUNYAMURTULA S KISHORE
Title or Position: PRESIDENT
Credential: MD
Phone: 617-264-9764