Healthcare Provider Details

I. General information

NPI: 1538707229
Provider Name (Legal Business Name): NATASSIA ILIKEA GORZEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BURLINGTON RD
BEDFORD MA
01730-1406
US

IV. Provider business mailing address

205 BURLINGTON RD STE 510
BEDFORD MA
01730-1406
US

V. Phone/Fax

Practice location:
  • Phone: 781-761-5089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: