Provider Demographics
NPI:1356044267
Name:UPSTREAM MENTAL HEALTH A PSYCHOLOGICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:UPSTREAM MENTAL HEALTH A PSYCHOLOGICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-221-3202
Mailing Address - Street 1:867 BOYLSTON STREET
Mailing Address - Street 2:5TH FLOOR, SUITE 1717
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2774
Mailing Address - Country:US
Mailing Address - Phone:617-221-3202
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON STREET
Practice Address - Street 2:5TH FLOOR, SUITE 1717
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:617-221-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty