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General NPI Number Information
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NPI Number | 1306087457
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Entity Type | Organization
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Legal Business Name | BOSTON BEHAVIORAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1371 BEACON ST STE 304
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City | BROOKLINE
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State | MA
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Zip | 02446-4905
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Country | US
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Telephone | 617-232-2435
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Fax | 617-232-0078
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Provider Business Mailing Address
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Address Line | 1371 BEACON ST STE 304
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City | BROOKLINE
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State | MA
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Zip | 02446-4905
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Country | US
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Telephone | 617-232-2435
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Fax | 617-232-0078
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | DR. KATHARINE M LARSSON
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Credential | PHD
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Telephone | 617-232-2435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 181401
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7454
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License Number State | MA
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