Provider Demographics
NPI:1740583327
Name:CENTER FOR ANXIETY AND RELATED DISORDERS AT BOSTON UNIVERSITY
Entity Type:Organization
Organization Name:CENTER FOR ANXIETY AND RELATED DISORDERS AT BOSTON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-353-9610
Mailing Address - Street 1:648 BEACON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2013
Mailing Address - Country:US
Mailing Address - Phone:617-353-9610
Mailing Address - Fax:617-353-9609
Practice Address - Street 1:648 BEACON ST STE 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2013
Practice Address - Country:US
Practice Address - Phone:617-353-9610
Practice Address - Fax:617-353-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4H8L103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty