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NPI Code Detail

MEDICARE: PHARA JEAN DENIS

MEDICARE: PHARA JEAN DENIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1053761973
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHARA JEAN DENIS
Provider Business Mailing Address
First Line : 39 WILLIAM ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-3833
Country : US
Telephone Number : 617-319-2021
Fax Number :
Provider Business Practice Location Address
First Line : 504 DUDLEY ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-2732
Country : US
Telephone Number : 617-445-6655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2016
Last Update Date : 06/22/2016

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Directions to “ PHARA JEAN DENIS ” Practice Location

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