Provider Demographics
NPI:1083400741
Name:SCULLY PSYCHOTHERAPY LLC.
Entity type:Organization
Organization Name:SCULLY PSYCHOTHERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:774-633-9443
Mailing Address - Street 1:176 MAPLE AVE APT 7-5
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1343
Mailing Address - Country:US
Mailing Address - Phone:508-450-9298
Mailing Address - Fax:508-450-9298
Practice Address - Street 1:176 MAPLE AVE APT 7-5
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-1343
Practice Address - Country:US
Practice Address - Phone:508-450-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty