Provider Demographics
NPI:1982283172
Name:BOSTON CHILD STUDY CENTER - MAINE, P.C.
Entity type:Organization
Organization Name:BOSTON CHILD STUDY CENTER - MAINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-299-0228
Mailing Address - Street 1:20 KENT CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3565
Mailing Address - Country:US
Mailing Address - Phone:631-553-0662
Mailing Address - Fax:
Practice Address - Street 1:68 COMMERCIAL ST FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5089
Practice Address - Country:US
Practice Address - Phone:207-200-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty