Provider Demographics
NPI:1184410300
Name:WILBRAHAM PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:WILBRAHAM PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILBRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-362-6848
Mailing Address - Street 1:867 BOYLSTON STREET
Mailing Address - Street 2:5TH FLOOR #1334
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-362-6848
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON STREET
Practice Address - Street 2:5TH FLOOR #1334
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-362-6848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty