Healthcare Provider Details

I. General information

NPI: 1396792628
Provider Name (Legal Business Name): TWO BRATTLE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 CHURCH ST
CAMBRIDGE MA
02138-3730
US

IV. Provider business mailing address

PO BOX 380187
CAMBRIDGE MA
02238-0187
US

V. Phone/Fax

Practice location:
  • Phone: 617-441-7500
  • Fax: 617-441-7510
Mailing address:
  • Phone: 617-441-7500
  • Fax: 617-441-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO BENITEZ
Title or Position: HR MANAGER
Credential:
Phone: 617-441-7500