Provider Demographics
NPI:1205229838
Name:ROBERT J. BOYLSTON INC.
Entity Type:Organization
Organization Name:ROBERT J. BOYLSTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-443-8480
Mailing Address - Street 1:152 NORTH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5118
Mailing Address - Country:US
Mailing Address - Phone:413-443-8480
Mailing Address - Fax:413-443-8455
Practice Address - Street 1:152 NORTH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5118
Practice Address - Country:US
Practice Address - Phone:413-443-8480
Practice Address - Fax:413-443-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1073151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06648Medicare UPIN