Provider Demographics
NPI:1770114951
Name:NEW ENGLAND CENTER FOR OCD AND ANXIETY BOSTON PLLC
Entity type:Organization
Organization Name:NEW ENGLAND CENTER FOR OCD AND ANXIETY BOSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-829-8491
Mailing Address - Street 1:612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3116
Mailing Address - Country:US
Mailing Address - Phone:401-829-8491
Mailing Address - Fax:
Practice Address - Street 1:612 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3116
Practice Address - Country:US
Practice Address - Phone:401-829-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110-138-102-AMedicaid
MA1669707592OtherNPI