Doctor Name: | DR. SIAMAK MOVAHEDI |
NPI Number: | 1427273697 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CERTIFIED PSYCHOANAL |
License Number: | 3297 |
Business Practice Address: | 252 Waban Ave Waban, MA - 024682108 |
Business Phone Number: | 6173323149 |
Business Fax Number: | 6172876288 |
Mailing Address: | 252 Waban Ave, WABAN |
State: | MA |
Postal Code: | 024682108 |
Phone Number: | 6173323149 |
Fax Number: | 6172876288 |
NPI Enumeration Date: | 04/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3297 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |