Healthcare Provider Details

I. General information

NPI: 1770424723
Provider Name (Legal Business Name): BOSTON PREMIER PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST STE 320
WELLESLEY HILLS MA
02481-2184
US

IV. Provider business mailing address

23 BLUEBIRD RD
WELLESLEY HILLS MA
02481-3504
US

V. Phone/Fax

Practice location:
  • Phone: 508-960-9611
  • Fax: 781-208-7365
Mailing address:
  • Phone: 508-960-9611
  • Fax: 781-208-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MALINI PRABHU
Title or Position: OWNER
Credential: MD
Phone: 508-960-9611