| Doctor Name: | PHALNARITH BA |
| NPI Number: | 1114064656 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OUT REACH WORKER |
| License Number: | |
| Business Practice Address: | 265 Beach St Revere, MA - 021513131 |
| Business Phone Number: | 6179127732 |
| Business Fax Number: | 7812865636 |
| Mailing Address: | 265 Beach St, REVERE |
| State: | MA |
| Postal Code: | 021513131 |
| Phone Number: | 6179127732 |
| Fax Number: | 7812865636 |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |