Provider Demographics
NPI:1073015194
Name:GREATER BOSTON WELLNESS GROUP
Entity Type:Organization
Organization Name:GREATER BOSTON WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRYATINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-383-7894
Mailing Address - Street 1:77 WARREN ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-383-7804
Mailing Address - Fax:888-857-0151
Practice Address - Street 1:77 WARREN ST BLDG 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-383-7804
Practice Address - Fax:888-857-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)