Basic Information
| Provider Information | |||||||||
| NPI: | 1093051948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON CENTER FOR PSYCHOTHERAPY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1093 BEACON ST | ||||||||
| Address2: | 304 | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024465695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178342960 | ||||||||
| FaxNumber: | 6172321160 | ||||||||
| Practice Location | |||||||||
| Address1: | 1093 BEACON ST | ||||||||
| Address2: | 304 | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024465695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178342960 | ||||||||
| FaxNumber: | 6172321160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2012 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | LAUCK | ||||||||
| AuthorizedOfficialFirstName: | JULIDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6178342960 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7024 | MA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.