Provider Demographics
NPI:1003300385
Name:BRIDGE TO HEALING PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:BRIDGE TO HEALING PSYCHOTHERAPY LLC
Other - Org Name:BRIDGE TO HEALING PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-640-2078
Mailing Address - Street 1:611 MAIN ST STE 302E
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2051
Mailing Address - Country:US
Mailing Address - Phone:781-640-2078
Mailing Address - Fax:781-723-8566
Practice Address - Street 1:611 MAIN ST STE 302E
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2051
Practice Address - Country:US
Practice Address - Phone:781-640-2078
Practice Address - Fax:781-723-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1437138138OtherNPI TYPE 1