Healthcare Provider Details

I. General information

NPI: 1790863769
Provider Name (Legal Business Name): MOSHE WURGAFT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 N PLEASANT ST SUITE 1A
AMHERST MA
01002-1736
US

IV. Provider business mailing address

256 N PLEASANT ST SUITE 1A
AMHERST MA
01002-1736
US

V. Phone/Fax

Practice location:
  • Phone: 413-230-7027
  • Fax: 866-398-8498
Mailing address:
  • Phone: 413-230-7027
  • Fax: 866-398-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6055
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: