Provider Demographics
NPI:1992191985
Name:GOLDEN BOXER LLC
Entity Type:Organization
Organization Name:GOLDEN BOXER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-596-7071
Mailing Address - Street 1:315 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3837
Mailing Address - Country:US
Mailing Address - Phone:617-596-7071
Mailing Address - Fax:
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 21-22
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4007
Practice Address - Country:US
Practice Address - Phone:781-214-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112152261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)