Organization
BOSTON BEHAVIORAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHARINE M LARSSON PHD (CO-DIRECTOR)
(617) 232-2435
Entity
Organization
Contact information
Practice address
1371 BEACON ST STE 304, BROOKLINE, MA 02446-4905
(617) 232-2435
(617) 232-0078
Mailing address
1371 BEACON ST STE 304, BROOKLINE, MA 02446-4905
(617) 232-2435
(617) 232-0078
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7454
MA
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
181401
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000PN0601
BLUE CROSS BLUE SHIELD LEGACY NUMBER
—
01
—
0000WO6099
BLUE CROSS BLUE SHIELD LEGACY NUMBER
—
01
—
1003850330
NPI
MA
01
—
1030430
BEACON HEALTH STRATEGIES
MA
01
—
1093165
MBHP
MA
01
—
1790817732
NPI
MA
05
—
1893165
—
MA
01
—
461385
TUFTS HEALTH INSURANCE
MA
01
—
791373
TUFTS HEALTH INSURANCE
MA
01
—
IP574730
MEGELLAN
—
01
—
LAW51023
MEDICARE
MA
Enumeration date
03/19/2009
Last updated
03/19/2009
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