Basic Information
Provider Information
NPI: 1174644272
EntityType: 2
ReplacementNPI:  
OrganizationName: ARBOUR COUNSELING
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: HRI CLINICS BROOKLINE MA 024446 1099 MISC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14 FORDHAM RD
Address2:  
City: ALLSTON
State: MA
PostalCode: 021343006
CountryCode: US
TelephoneNumber: 6177826460
FaxNumber: 6177826457
Practice Location
Address1: 14 FORDHAM RD
Address2:  
City: ALLSTON
State: MA
PostalCode: 021343006
CountryCode: US
TelephoneNumber: 6177826460
FaxNumber: 6177826457
Other Information
ProviderEnumerationDate: 04/03/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MILETSKY
AuthorizedOfficialFirstName: VERONICA
AuthorizedOfficialMiddleName: ANNE
AuthorizedOfficialTitleorPosition: LICENSED MENTAL HEALTH COUNSELOR
AuthorizedOfficialTelephone: 6177826460
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QH0100X  Y Ambulatory Health Care FacilitiesClinic/CenterHealth Service

No ID Information.


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