Provider Demographics
NPI:1184892614
Name:THE OSIRIS GROUP
Entity type:Organization
Organization Name:THE OSIRIS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINBOTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LCSW
Authorized Official - Phone:617-442-2004
Mailing Address - Street 1:184 DUDLEY ST
Mailing Address - Street 2:SUITE 107LL
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2561
Mailing Address - Country:US
Mailing Address - Phone:617-442-2002
Mailing Address - Fax:617-442-4002
Practice Address - Street 1:184 DUDLEY ST
Practice Address - Street 2:SUITE 107LL
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2561
Practice Address - Country:US
Practice Address - Phone:617-442-2002
Practice Address - Fax:617-442-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health