Provider Demographics
NPI:1902267602
Name:NEW ENGLAND CONSERVATORY
Entity Type:Organization
Organization Name:NEW ENGLAND CONSERVATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN OF STUDENTS
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-585-1311
Mailing Address - Street 1:290 HUNTINGTON AVE
Mailing Address - Street 2:SB112
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5018
Mailing Address - Country:US
Mailing Address - Phone:617-585-1284
Mailing Address - Fax:617-585-1208
Practice Address - Street 1:241 SAINT BOTOLPH ST RM 112
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-4918
Practice Address - Country:US
Practice Address - Phone:617-585-1284
Practice Address - Fax:617-585-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168572261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health