Provider Demographics
NPI:1740342674
Name:GOLDEN PSYCHOTHERAPY ASSOCIATES
Entity type:Organization
Organization Name:GOLDEN PSYCHOTHERAPY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-277-3490
Mailing Address - Street 1:79 STEDMAN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6008
Mailing Address - Country:US
Mailing Address - Phone:617-277-3490
Mailing Address - Fax:617-738-2924
Practice Address - Street 1:364 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2920
Practice Address - Country:US
Practice Address - Phone:617-277-3490
Practice Address - Fax:617-738-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10386OtherBC-BS GROUP NO.