Healthcare Provider Details

I. General information

NPI: 1962035840
Provider Name (Legal Business Name): AMINA FOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 STATE ST
BOSTON MA
02109-2202
US

IV. Provider business mailing address

PO BOX 1595
MIDDLETOWN CT
06457-8095
US

V. Phone/Fax

Practice location:
  • Phone: 860-788-6404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2322938
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: