Healthcare Provider Details

I. General information

NPI: 1043767114
Provider Name (Legal Business Name): BI TOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RIVER ST
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

20 RIVER ST
MARLBOROUGH MA
01752-3242
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-3333
  • Fax:
Mailing address:
  • Phone: 404-370-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: