Organization
BOSTON NEUROPSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN A DOMINGOS PH.D. (CLINICAL DIRECTOR)
(781) 559-8444
Entity
Organization
Contact information
Practice address
687 HIGHLAND AVENUE, 2ND FLOOR, NEEDHAM, MA 02494
(781) 559-8444
(781) 559-8117
Mailing address
687 HIGHLAND AVENUE, 2ND FLOOR, NEEDHAM, MA 02494-2409
(781) 559-8444
(781) 559-8117
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103G00000X
Clinical Neuropsychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W10647
BLUE CROSS/BLUE SHIELD
MA
Enumeration date
08/14/2007
Last updated
05/29/2019
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