Provider Demographics
NPI:1699058370
Name:INNOVATIVE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:INNOVATIVE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-259-1895
Mailing Address - Street 1:160 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE U3-A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2707
Mailing Address - Country:US
Mailing Address - Phone:617-259-1895
Mailing Address - Fax:617-259-1899
Practice Address - Street 1:160 COMMONWEALTH AVE
Practice Address - Street 2:SUITE U3-A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2707
Practice Address - Country:US
Practice Address - Phone:617-259-1895
Practice Address - Fax:617-259-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty