Provider Demographics
NPI:1861611592
Name:COUNSELING & PSYCHOTHERAPY CENTER OF GREATER BOSTON, INC.
Entity type:Organization
Organization Name:COUNSELING & PSYCHOTHERAPY CENTER OF GREATER BOSTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:APP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-455-8726
Mailing Address - Street 1:687 HIGHLAND AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2232
Mailing Address - Country:US
Mailing Address - Phone:800-455-8726
Mailing Address - Fax:
Practice Address - Street 1:687 HIGHLAND AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:800-455-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01363251S00000X
MAMA100144251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME153410000Medicaid
ME431882600Medicaid
RITC18547Medicaid
RI1022840Medicaid