Healthcare Provider Details

I. General information

NPI: 1285549485
Provider Name (Legal Business Name): DR. PARSA RAVANFAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 502
BROOKLINE MA
02445-7277
US

IV. Provider business mailing address

1 BROOKLINE PL STE 502
BROOKLINE MA
02445-7277
US

V. Phone/Fax

Practice location:
  • Phone: 617-651-0170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PARSA RAVANFAR
Title or Position: MANAGER
Credential: MD
Phone: 617-651-0170