Provider Demographics
NPI:1275694234
Name:BROOKLINE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BROOKLINE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:617-734-2007
Mailing Address - Street 1:9 BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5903
Mailing Address - Country:US
Mailing Address - Phone:617-734-2007
Mailing Address - Fax:617-734-7165
Practice Address - Street 1:9 BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5903
Practice Address - Country:US
Practice Address - Phone:617-734-2007
Practice Address - Fax:617-734-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10149OtherBLUE CROSS BLUE SHIELD