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NPI Code Detail

MEDICARE: BOSTON CHILD STUDY CENTER PSYCHOLOGY SERVICES

MEDICARE: BOSTON CHILD STUDY CENTER PSYCHOLOGY SERVICES
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

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

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Directions to “BOSTON CHILD STUDY CENTER PSYCHOLOGY SERVICES ” Practice Location

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