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General NPI Number Information
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NPI Number | 1972239242
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Entity Type | Organization
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Legal Business Name | BOSTON CHILD STUDY CENTER PSYCHOLOGY SERVICES
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 11900 W OLYMPIC BLVD STE 410
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City | LOS ANGELES
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State | CA
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Zip | 90064-1168
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Country | US
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Telephone | 617-299-0228
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Fax |
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Provider Business Mailing Address
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Address Line | 729 BOYLSTON ST FL 5
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City | BOSTON
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State | MA
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Zip | 02116-2639
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Country | US
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Telephone | 617-299-0228
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN MADIGAN
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Credential | PSY.D.
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Telephone | 617-299-0228
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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 |
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License Number State |
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