Provider Demographics
NPI:1477123248
Name:EMBODIED INSIGHT COUNSELING
Entity Type:Organization
Organization Name:EMBODIED INSIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCH DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-616-8491
Mailing Address - Street 1:1770 MASSACHUSETTS AVE # 116
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2808
Mailing Address - Country:US
Mailing Address - Phone:617-616-8491
Mailing Address - Fax:
Practice Address - Street 1:185 DEVONSHIRE ST STE 701
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1413
Practice Address - Country:US
Practice Address - Phone:617-616-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1629564133Medicaid