Provider Demographics
NPI:1720172695
Name:BRIGHAM AND WOMENS HOSPITAL
Entity type:Organization
Organization Name:BRIGHAM AND WOMENS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-983-4227
Mailing Address - Street 1:42 RUSTIC ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1024
Mailing Address - Country:US
Mailing Address - Phone:617-983-4233
Mailing Address - Fax:617-983-4246
Practice Address - Street 1:640 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2555
Practice Address - Country:US
Practice Address - Phone:617-983-4233
Practice Address - Fax:617-983-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8610261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health