Provider Demographics
NPI:1235396342
Name:AHIMSA CENTER FOR GROWTH AND DEVELOPMENT
Entity Type:Organization
Organization Name:AHIMSA CENTER FOR GROWTH AND DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-698-0998
Mailing Address - Street 1:464 GRANITE AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5625
Mailing Address - Country:US
Mailing Address - Phone:617-698-0991
Mailing Address - Fax:617-698-1274
Practice Address - Street 1:464 GRANITE AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5625
Practice Address - Country:US
Practice Address - Phone:617-698-0991
Practice Address - Fax:617-698-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
MA466232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty