Organization
NEWTON-WELLESLEY PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE COPPOLA (CREDENTIALING COORDINATOR)
(617) 332-2047
Entity
Organization
Contact information
Practice address
40 WALNUT ST STE 302, WELLESLEY, MA 02481-2175
(617) 332-2047
(617) 332-7341
Mailing address
2364 WASHINGTON ST, NEWTON, MA 02462-1440
(617) 332-2047
(617) 332-7341
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
MA
1041C0700X
Clinical Social Worker
—
MA
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
MA
2084P0800X
Psychiatry Physician
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9756981
—
MA
01
—
M14702
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/30/2006
Last updated
07/26/2023
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