Provider Demographics
NPI:1467745109
Name:BROOKLINE COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:BROOKLINE COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:THE BROOKLINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:857-707-3481
Mailing Address - Street 1:43 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4445
Mailing Address - Country:US
Mailing Address - Phone:617-277-8107
Mailing Address - Fax:617-734-6385
Practice Address - Street 1:43 GARRISON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4445
Practice Address - Country:US
Practice Address - Phone:617-277-8107
Practice Address - Fax:617-734-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health