Provider Demographics
NPI:1972930063
Name:MASSACHUSETTS MIND CENTER LLC
Entity Type:Organization
Organization Name:MASSACHUSETTS MIND CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-935-3678
Mailing Address - Street 1:184 COMMONWEALTH AVE
Mailing Address - Street 2:10
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:376 BOYLSTON ST
Practice Address - Street 2:STE 403
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3812
Practice Address - Country:US
Practice Address - Phone:617-935-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240591261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center