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General NPI Number Information
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NPI Number | 1518246131
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Entity Type | Organization
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Legal Business Name | BOSTON PSYCHIATRIC CARE LLC
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 11 GREEN ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2588
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Country | US
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Telephone | 617-830-1644
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Fax | 617-830-1644
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Provider Business Mailing Address
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Address Line | 11 GREEN ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2588
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Country | US
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Telephone | 617-830-1644
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Fax | 617-830-1644
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Authorized Official
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Title or Position | CLINICAL NURSE SPECIALIST
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Name | DANIELLE MARIE FEDOROV
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Credential | RN CNS
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Telephone | 617-830-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 271091
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 271091
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License Number State | MA
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