Provider Demographics
NPI:1811742414
Name:BOSTON EXPRESSIVE ARTS THERAPY SERVICES LLC
Entity type:Organization
Organization Name:BOSTON EXPRESSIVE ARTS THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-319-9850
Mailing Address - Street 1:402A HIGHLAND AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2511
Mailing Address - Country:US
Mailing Address - Phone:508-319-9850
Mailing Address - Fax:
Practice Address - Street 1:402A HIGHLAND AVE STE K
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2511
Practice Address - Country:US
Practice Address - Phone:508-319-9850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center