Provider Demographics
NPI:1609360510
Name:TRUSTEES OF TUFTS COLLEGE
Entity type:Organization
Organization Name:TRUSTEES OF TUFTS COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-636-6505
Mailing Address - Street 1:200 HARRISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1836
Mailing Address - Country:US
Mailing Address - Phone:617-636-0451
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTEES OF TUFTS COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty