Provider Demographics
NPI:1669096996
Name:EAST BOSTON BEHAVIORAL HEALTH AND MEDICINE LLC
Entity type:Organization
Organization Name:EAST BOSTON BEHAVIORAL HEALTH AND MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:FERREIRA
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-567-9200
Mailing Address - Street 1:464 BREMEN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1430
Mailing Address - Country:US
Mailing Address - Phone:617-359-2146
Mailing Address - Fax:
Practice Address - Street 1:464 BREMEN ST STE 4
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1430
Practice Address - Country:US
Practice Address - Phone:617-567-9200
Practice Address - Fax:617-567-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty