Basic Information
| Provider Information | |||||||||
| NPI: | 1447808431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON CENTER FOR CLINICAL RESEARCH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
| FaxNumber: | 6175816040 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 UNION ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017607700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
| FaxNumber: | 6175816040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2019 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | KINRYS | ||||||||
| AuthorizedOfficialFirstName: | GUSTAVO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6172443322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.