Healthcare Provider Details

I. General information

NPI: 1518043587
Provider Name (Legal Business Name): BOSTONNEUROBEHAVIORALASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BRIDGE ST
DEDHAM MA
02026-1765
US

IV. Provider business mailing address

80 BRIDGE ST
DEDHAM MA
02026-1765
US

V. Phone/Fax

Practice location:
  • Phone: 781-492-1689
  • Fax:
Mailing address:
  • Phone: 781-492-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateMA

VIII. Authorized Official

Name: LAURIE PITCHFORD
Title or Position: DIRECTOROFOUTPATIENTSERVICES
Credential: LSW
Phone: 17814921689