Provider Demographics
NPI:1730735408
Name:BROOKLINE PSYCHOLOGIST PLLC
Entity type:Organization
Organization Name:BROOKLINE PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-294-0712
Mailing Address - Street 1:57 MOUNT WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5108
Mailing Address - Country:US
Mailing Address - Phone:617-294-0712
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON STREET 8W STE 4
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-0244
Practice Address - Country:US
Practice Address - Phone:617-294-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-17
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty