Provider Demographics
NPI:1427453000
Name:WALTHAM BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:WALTHAM BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEFTHERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAVOUSSIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMSCNSBC
Authorized Official - Phone:781-966-0070
Mailing Address - Street 1:210 BEAR HILL ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1025
Mailing Address - Country:US
Mailing Address - Phone:781-966-0070
Mailing Address - Fax:781-915-0755
Practice Address - Street 1:210 BEAR HILL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1025
Practice Address - Country:US
Practice Address - Phone:781-966-0070
Practice Address - Fax:781-915-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 163WP0809X, 2084P0804X
MA7194103TC0700X
MA1133141041C0700X
MA205807363LP0808X
MA280722363LP0808X
MA175264364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty