Provider Demographics
NPI:1962720409
Name:BOSTON PSYCHOTHERAPY ASSOCIATES
Entity type:Organization
Organization Name:BOSTON PSYCHOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KOSLOF
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-262-3751
Mailing Address - Street 1:224 CLARENDON STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-262-3751
Mailing Address - Fax:
Practice Address - Street 1:224 CLARENDON STREET
Practice Address - Street 2:SUITE 22
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-262-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2252103T00000X
MA106216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty