Provider Demographics
NPI:1790262541
Name:BOSTON PSYCHOTHERAPY, PLC
Entity type:Organization
Organization Name:BOSTON PSYCHOTHERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-681-8548
Mailing Address - Street 1:2568 LINCOLN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05738-9645
Mailing Address - Country:US
Mailing Address - Phone:802-681-8548
Mailing Address - Fax:
Practice Address - Street 1:128 MERCHANTS ROW STE 201
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5916
Practice Address - Country:US
Practice Address - Phone:802-236-0842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020156Medicaid
NY03967782Medicaid