Provider Demographics
NPI:1851664767
Name:COMPREHENSIVE PSYCHIATRIC RESOURCES
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHIATRIC RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-647-0066
Mailing Address - Street 1:203 CRESCENT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-647-0066
Mailing Address - Fax:781-899-4905
Practice Address - Street 1:203 CRESCENT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-647-0066
Practice Address - Fax:781-899-4905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE PSYCHIATRIC RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty