Provider Demographics
NPI:1609142017
Name:BOSTON CENTER FOR MEMORY, INC
Entity Type:Organization
Organization Name:BOSTON CENTER FOR MEMORY, INC
Other - Org Name:BOSTON CENTER FOR MEMORY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-993-7168
Mailing Address - Street 1:180 WELLS AVE.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-699-6927
Mailing Address - Fax:617-383-5874
Practice Address - Street 1:180 WELLS AVE.
Practice Address - Street 2:SUITE 304
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-699-6927
Practice Address - Fax:617-383-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty