Provider Demographics
NPI:1417367004
Name:BOSTON EVENING THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BOSTON EVENING THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-738-1480
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-738-1480
Mailing Address - Fax:617-738-1481
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-738-1480
Practice Address - Fax:617-738-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty