Provider Demographics
NPI:1568127157
Name:HYDE PARK BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HYDE PARK BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP-BC
Authorized Official - Phone:617-413-6618
Mailing Address - Street 1:1234 HYDE PARK AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2819
Mailing Address - Country:US
Mailing Address - Phone:617-413-6618
Mailing Address - Fax:617-333-8229
Practice Address - Street 1:1234 HYDE PARK AVE STE 205
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-2819
Practice Address - Country:US
Practice Address - Phone:617-413-6618
Practice Address - Fax:617-333-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty