Healthcare Provider Details

I. General information

NPI: 1821934589
Provider Name (Legal Business Name): COMPOS MENTIS NEUROPSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 COURTFIELD AVE
WINCHESTER VA
22601-3204
US

IV. Provider business mailing address

8401 MAYLAND DR STE A
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 617-997-1691
  • Fax:
Mailing address:
  • Phone: 617-997-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS CHARLES BOSTON
Title or Position: OWNER
Credential: PSY.D.
Phone: 617-997-1691