Provider Demographics
NPI:1063764876
Name:COUNSELING SERVICES OF GREATER BOSTON
Entity type:Organization
Organization Name:COUNSELING SERVICES OF GREATER BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:HS
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-304-1678
Mailing Address - Street 1:7 LINCOLN ST
Mailing Address - Street 2:#309A
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3021
Mailing Address - Country:US
Mailing Address - Phone:617-304-1678
Mailing Address - Fax:
Practice Address - Street 1:7 LINCOLN ST
Practice Address - Street 2:#309A
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3021
Practice Address - Country:US
Practice Address - Phone:617-304-1678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty