Healthcare Provider Details

I. General information

NPI: 1295639219
Provider Name (Legal Business Name): BOSTON INTEGRATED RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 WALNUT ST STE 412
NEWTON MA
02460-2062
US

IV. Provider business mailing address

46 FAIRVIEW ST
DEDHAM MA
02026-3254
US

V. Phone/Fax

Practice location:
  • Phone: 724-747-3934
  • Fax:
Mailing address:
  • Phone: 724-747-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM CODY
Title or Position: OWNER
Credential: LICSW
Phone: 724-747-3934