Provider Demographics
NPI:1992273338
Name:BOSTON CHILD STUDY CENTER LOS ANGELES LICENSED CLINICAL SOCIAL WORK SE
Entity type:Organization
Organization Name:BOSTON CHILD STUDY CENTER LOS ANGELES LICENSED CLINICAL SOCIAL WORK SE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-299-0228
Mailing Address - Street 1:729 BOYLSTON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2639
Mailing Address - Country:US
Mailing Address - Phone:617-299-0228
Mailing Address - Fax:
Practice Address - Street 1:11400 W OLYMPIC BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1584
Practice Address - Country:US
Practice Address - Phone:888-225-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty