Provider Demographics
NPI:1871326942
Name:PATHWAY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PATHWAY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:KENARY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-916-0438
Mailing Address - Street 1:33 SOLEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3310
Mailing Address - Country:US
Mailing Address - Phone:860-916-0438
Mailing Address - Fax:
Practice Address - Street 1:185 DEVONSHIRE ST STE 501
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1415
Practice Address - Country:US
Practice Address - Phone:617-334-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty