Provider Demographics
NPI:1326820119
Name:BACK BAY PSYCHIATRY,LLC
Entity Type:Organization
Organization Name:BACK BAY PSYCHIATRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN, FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGLIERI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC
Authorized Official - Phone:617-680-5205
Mailing Address - Street 1:60 MYOPIA RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3745
Mailing Address - Country:US
Mailing Address - Phone:617-680-5205
Mailing Address - Fax:
Practice Address - Street 1:264 BEACON ST FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:857-278-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)