Healthcare Provider Details

I. General information

NPI: 1487085296
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AND CONSULTING PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 WALNUT ST
NEWTON MA
02459-1756
US

IV. Provider business mailing address

PO BOX 620024
NEWTON MA
02462-0024
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-0422
  • Fax: 617-332-0423
Mailing address:
  • Phone: 617-332-0422
  • Fax: 617-332-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN154473
License Number StateMA

VIII. Authorized Official

Name: MS. SHARON REYNOLDS
Title or Position: SOLE MEMBER, OWNER
Credential: RN, PC
Phone: 617-332-0422