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General NPI Number Information
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NPI Number | 1891577664
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Entity Type | Organization
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Legal Business Name | BOSTON PSYCHIATRIC ALLIANCE
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 26 WOLCOTT RD
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City | MILTON
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State | MA
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Zip | 02186-1222
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Country | US
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Telephone | 617-291-1440
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Fax | 617-361-1105
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Provider Business Mailing Address
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Address Line | 26 WOLCOTT RD
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City | MILTON
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State | MA
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Zip | 02186-1222
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Country | US
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Telephone | 617-291-1440
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Fax | 617-361-1105
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | JAN PETER URKEVIC
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Credential | MD
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Telephone | 617-291-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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