Healthcare Provider Details

I. General information

NPI: 1205934924
Provider Name (Legal Business Name): BOSTON PSYCHIATRY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOPE AVE STE G05
WALTHAM MA
02453-2781
US

IV. Provider business mailing address

53 FELLSMERE RD
NEWTON MA
02459-1339
US

V. Phone/Fax

Practice location:
  • Phone: 781-893-8762
  • Fax: 781-899-6386
Mailing address:
  • Phone: 781-893-8762
  • Fax: 781-899-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number50268
License Number StateMA

VIII. Authorized Official

Name: DR. TANYA YANOVSKY
Title or Position: OWNER
Credential: M.D.
Phone: 781-893-8762