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General NPI Number Information
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NPI Number | 1073619854
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Entity Type | Organization
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Legal Business Name | BOSTON UNIVERSITY PSYCHIATRY ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 1 BOSTON MEDICAL CTR PL
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City | BOSTON
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State | MA
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Zip | 02118-2908
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Country | US
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Telephone | 617-414-5245
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Fax | 617-414-5520
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE FL 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID C. HENDERSON
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Credential | MD
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Telephone | 617-638-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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