Healthcare Provider Details

I. General information

NPI: 1588709125
Provider Name (Legal Business Name): BOSTON FORENSIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WASHINGTON ST STE 203
DEDHAM MA
02026-1870
US

IV. Provider business mailing address

339 WASHINGTON ST STE 203
DEDHAM MA
02026-1870
US

V. Phone/Fax

Practice location:
  • Phone: 781-326-0200
  • Fax:
Mailing address:
  • Phone: 781-326-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J MENDOZA
Title or Position: PARTNER
Credential: PSYD
Phone: 781-326-0200