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General NPI Number Information
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NPI Number | 1518043587
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Entity Type | Organization
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Legal Business Name | BOSTONNEUROBEHAVIORALASSOCIATES
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 80 BRIDGE ST
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City | DEDHAM
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State | MA
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Zip | 02026-1765
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Country | US
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Telephone | 781-492-1689
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Fax |
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Provider Business Mailing Address
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Address Line | 80 BRIDGE ST
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City | DEDHAM
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State | MA
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Zip | 02026-1765
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Country | US
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Telephone | 781-492-1689
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Fax |
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Authorized Official
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Title or Position | DIRECTOROFOUTPATIENTSERVICES
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Name | LAURIE PITCHFORD
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Credential | LSW
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Telephone | 17814921689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State | MA
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