Provider Demographics
NPI:1205231941
Name:BOSTON PUBLIC HEALTH COMMISSION
Entity Type:Organization
Organization Name:BOSTON PUBLIC HEALTH COMMISSION
Other - Org Name:BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJIKUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-534-5264
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-5264
Mailing Address - Fax:
Practice Address - Street 1:1226 COLUMBIA RD # A
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3978
Practice Address - Country:US
Practice Address - Phone:617-534-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4YHQ261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001542402OtherMEDICARE PTAN
MA4YHQOtherMENTAL HEALTH LICENSE
MA110025617/GMedicaid