Provider Demographics
NPI:1457453920
Name:BOSTON NEUROFEEDBACK CTR., PC
Entity Type:Organization
Organization Name:BOSTON NEUROFEEDBACK CTR., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREMGOLD-MYER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:781-229-6700
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-2200
Mailing Address - Fax:781-933-2220
Practice Address - Street 1:60 MALL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4517
Practice Address - Country:US
Practice Address - Phone:781-229-6700
Practice Address - Fax:781-229-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21043Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE