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General NPI Number Information
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NPI Number | 1265830061
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Entity Type | Organization
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Legal Business Name | WALDEN PSYCHIATRIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 203 CRESCENT ST
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City | WALTHAM
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State | MA
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Zip | 02453-3474
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Country | US
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Telephone | 781-647-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 51 SAWYER RD TWO UNIVERSITY OFFICE PARK
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City | WALTHAM
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State | MA
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Zip | 02453-3448
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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 | CHIEF MEDICAL OFFICER
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Name | JAMES GREENBLATT
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Credential | MD
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Telephone | 781-647-2901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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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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