Basic Information
Provider Information
NPI: 1609011832
EntityType: 2
ReplacementNPI:  
OrganizationName: BOSTON EMERGENCY SERVICES CRISIS STABILIZATION UNIT
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BEST CSU
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 85 E NEWTON ST
Address2: 6TH FLOOR
City: BOSTON
State: MA
PostalCode: 021182340
CountryCode: US
TelephoneNumber: 6176384920
FaxNumber: 6174141975
Practice Location
Address1: 85 E NEWTON ST
Address2: M802
City: BOSTON
State: MA
PostalCode: 021182340
CountryCode: US
TelephoneNumber: 6176384920
FaxNumber: 6174141975
Other Information
ProviderEnumerationDate: 12/02/2008
LastUpdateDate: 12/02/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FISHMAN
AuthorizedOfficialFirstName: LESLIE
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: ADMIN DIRECTOR
AuthorizedOfficialTelephone: 6176384934
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: BOSTON MEDICAL CENTER
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
273R00000X  Y Hospital UnitsPsychiatric Unit 

No ID Information.


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