Organization
THERAPEUTIC PSYCHIATRIC SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA LYDER PMH, CNS, BC (CLINICIAN/OWNER)
(617) 232-4570
Entity
Organization
Contact information
Practice address
131 HARVARD ST, BROOKLINE, MA 02446-6429
(617) 232-4570
Mailing address
131 HARVARD STREET, BROOKLINE, MA 02446
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
RN217927
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110073091A
—
MA
Enumeration date
10/18/2011
Last updated
10/18/2011
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