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Contact Information

SQUARE PSYCHIATRY
124 WATERTOWN ST
WATERTOWN, MA02472-2576
 Phone: 617-926-8200
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction Medicine

2084A0401X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for SQUARE PSYCHIATRY

NPI # 1609997667
LBN Legal business name SQUARE PSYCHIATRY
Authorized official BRIAN JOHNSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/03/2007
Last updated 09/11/2025 - About 9 months ago
Identifiers
MA License # 1023920
MA License # 43500
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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