Provider Demographics
NPI:1619602000
Name:MERIDIAN PSYCHOTHERAPY ASSOCIATES OF MASSACHUSETTS LLC
Entity Type:Organization
Organization Name:MERIDIAN PSYCHOTHERAPY ASSOCIATES OF MASSACHUSETTS LLC
Other - Org Name:MERIDIAN PSYCHOTHERAPY ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-872-3612
Mailing Address - Street 1:PO BOX 990001
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-0001
Mailing Address - Country:US
Mailing Address - Phone:617-872-3612
Mailing Address - Fax:
Practice Address - Street 1:101 ARCH ST FL 8
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-7500
Practice Address - Country:US
Practice Address - Phone:617-872-3612
Practice Address - Fax:617-608-5968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN HEALTH GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty