Healthcare Provider Details

I. General information

NPI: 1629526173
Provider Name (Legal Business Name): SIOBHAN MALAGUTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 101W
BURLINGTON MA
01803-5152
US

IV. Provider business mailing address

67 S BEDFORD ST STE 101W
BURLINGTON MA
01803-5152
US

V. Phone/Fax

Practice location:
  • Phone: 617-865-2921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC12484
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: