Organization
ACADEMIC & BEHAVIORAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRI BETTS (EXECUTIVE DIRECTOR)
(617) 822-0829
Entity
Organization
Contact information
Practice address
995 BLUE HILL AVE, DORCHESTER CENTER, MA 02124-2828
(617) 822-0829
(617) 825-7804
Mailing address
PO BOX 190789, BOSTON, MA 02119-0015
(617) 822-0829
(617) 825-7804
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4D1R
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073500
NEIGHBORHOOD HEALTH PLAN
MA
01
—
1301462
MASSACHUSETTS BEHAVIORAL PARTNERSHIP
MA
01
—
W10655
BLUE CROSS & BLUE SHIELD
MA
Enumeration date
05/07/2007
Last updated
02/16/2012
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