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NPI Code Detail

MEDICARE: BOSTON CHILD & ADOLESCENT ASSESSMENT LLC

MEDICARE: BOSTON CHILD & ADOLESCENT ASSESSMENT LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist9236MA

General Provider Information

NPI Number : 1306217237
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOSTON CHILD & ADOLESCENT ASSESSMENT LLC
Provider Business Mailing Address
First Line : PO BOX 83
Second Line :
City : SWAMPSCOTT
State : MA
Zip : 01907-0083
Country : US
Telephone Number : 617-600-6342
Fax Number : 888-975-4481
Provider Business Practice Location Address
First Line : 124 WATERTOWN ST
Second Line : SUITE 3A EAST
City : WATERTOWN
State : MA
Zip : 02472-2576
Country : US
Telephone Number : 617-600-6342
Fax Number : 888-975-4481
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : CHRISTINE SADOWSKI
Credential : PHD
Telephone Number : 617-600-6342
Provider Enumeration Date : 10/19/2015
Last Update Date : 10/19/2015

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Directions to “BOSTON CHILD & ADOLESCENT ASSESSMENT LLC ” Practice Location

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