Provider Demographics
NPI:1346329463
Name:BOSTON ALCOHOL AND SUBSTANCE ABUSE PROGRAM
Entity Type:Organization
Organization Name:BOSTON ALCOHOL AND SUBSTANCE ABUSE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:617-482-5292
Mailing Address - Street 1:30 WINTER ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4720
Mailing Address - Country:US
Mailing Address - Phone:617-482-5292
Mailing Address - Fax:617-482-5232
Practice Address - Street 1:30 WINTER ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4720
Practice Address - Country:US
Practice Address - Phone:617-482-5292
Practice Address - Fax:617-482-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0585261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1013160OtherNEIGHBORHOOD HEALTH PLAN
MA2223020540OtherBLUE CROSS BLUE SHIELD
MA1312626OtherMASSHEALTH