Healthcare Provider Details

I. General information

NPI: 1841643699
Provider Name (Legal Business Name): GREATER BOSTON PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST UNIT 111E
MEDWAY MA
02053-1584
US

IV. Provider business mailing address

165 MAIN ST UNIT 111E
MEDWAY MA
02053-1584
US

V. Phone/Fax

Practice location:
  • Phone: 508-321-3210
  • Fax:
Mailing address:
  • Phone: 508-321-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberRN272217
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberRN272217
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN272217
License Number StateMA

VIII. Authorized Official

Name: CARYN METZGER
Title or Position: OWNER
Credential: PMHCNS
Phone: 617-312-2825