Healthcare Provider Details

I. General information

NPI: 1538760707
Provider Name (Legal Business Name): NEW ENGLAND COGNITIVE BEHAVIOR THERAPY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WELLS AVE STE 1
NEWTON MA
02459-3263
US

IV. Provider business mailing address

396 WASHINGTON ST # 303
WELLESLEY MA
02481-6209
US

V. Phone/Fax

Practice location:
  • Phone: 781-731-9977
  • Fax:
Mailing address:
  • Phone: 781-731-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KALEY DESSAUER
Title or Position: FOUNDER
Credential: LICSW
Phone: 781-731-9977