Provider Demographics
NPI:1104570019
Name:QUETZALLI ZEPHYR, INC.
Entity type:Organization
Organization Name:QUETZALLI ZEPHYR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-388-9306
Mailing Address - Street 1:3 TRAYMORE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2213
Mailing Address - Country:US
Mailing Address - Phone:617-388-9306
Mailing Address - Fax:
Practice Address - Street 1:126 HARVARD ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6426
Practice Address - Country:US
Practice Address - Phone:617-388-9306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty