Provider Demographics
NPI:1851686455
Name:BEHAVIORAL NUTRITION INC
Entity Type:Organization
Organization Name:BEHAVIORAL NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-372-3733
Mailing Address - Street 1:1266 FURNACE BROOK PKWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4758
Mailing Address - Country:US
Mailing Address - Phone:617-595-7044
Mailing Address - Fax:888-434-5097
Practice Address - Street 1:1266 FURNACE BROOK PKWY
Practice Address - Street 2:SUITE 404
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4758
Practice Address - Country:US
Practice Address - Phone:617-595-7044
Practice Address - Fax:888-434-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5757101YA0400X, 101YM0800X, 101YP2500X
MA75391103TP0016X
133V00000X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty