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General NPI Number Information
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NPI Number | 1881844975
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Entity Type | Organization
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Legal Business Name | BOSTON EVENING THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 7 KENT ST UNIT 3
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City | BROOKLINE
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State | MA
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Zip | 02445-7959
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Country | US
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Telephone | 617-738-1480
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Fax | 617-738-1488
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Provider Business Mailing Address
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Address Line | 831 BEACON ST #101
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City | NEWTON
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State | MA
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Zip | 02459-1822
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Country | US
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Telephone | 617-738-1480
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Fax | 617-738-1488
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. AARON P GILBERT
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Credential | LICSW
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Telephone | 617-738-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1032829
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License Number State | MA
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