Organization
BOURNEWOOD CLINICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL C GALE (CFO)
(617) 469-0300
Entity
Organization
Contact information
Practice address
300 SOUTH ST, BROOKLINE, MA 02467-3658
(617) 469-0300
(617) 469-5013
Mailing address
300 SOUTH ST, BROOKLINE, MA 02467-3658
(617) 469-0300
(617) 469-5013
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9773908
—
MA
01
—
M15391
BLUE SHIELD PROVIDER NUMB
MA
Enumeration date
09/13/2005
Last updated
09/11/2025
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