Provider Demographics
NPI:1720423221
Name:BOSTON PROFESSIONALS COUNSELING, LLC
Entity Type:Organization
Organization Name:BOSTON PROFESSIONALS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LICSW
Authorized Official - Phone:508-740-1091
Mailing Address - Street 1:8 FANEUIL HALL MARKETPLACE FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-6110
Mailing Address - Country:US
Mailing Address - Phone:617-973-5015
Mailing Address - Fax:617-973-5031
Practice Address - Street 1:8 FANEUIL HALL MARKETPLACE FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-6110
Practice Address - Country:US
Practice Address - Phone:617-973-5015
Practice Address - Fax:617-973-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty