Provider Demographics
NPI:1669806147
Name:NORTHAMPTON PSYCHOTHERAPY
Entity type:Organization
Organization Name:NORTHAMPTON PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:413-207-2573
Mailing Address - Street 1:8 CRAFTS AVE
Mailing Address - Street 2:SUITE 2R
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3806
Mailing Address - Country:US
Mailing Address - Phone:413-207-2573
Mailing Address - Fax:
Practice Address - Street 1:8 CRAFTS AVE
Practice Address - Street 2:SUITE 2R
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3806
Practice Address - Country:US
Practice Address - Phone:413-207-2573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty