Healthcare Provider Details

I. General information

NPI: 1366162257
Provider Name (Legal Business Name): MAHEEN HABIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77F WARREN ST
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77F WARREN ST
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-1271
  • Fax: 617-782-7668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: