Healthcare Provider Details

I. General information

NPI: 1770703878
Provider Name (Legal Business Name): BROOKLINE PSYCHIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 BEACON ST
BROOKLINE MA
02445-4411
US

IV. Provider business mailing address

1685 BEACON ST
BROOKLINE MA
02445-4411
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-5888
  • Fax:
Mailing address:
  • Phone: 617-232-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number78737
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JANINA R GALLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-232-5888