Healthcare Provider Details

I. General information

NPI: 1134353279
Provider Name (Legal Business Name): YAEL ASSAF-GRUZMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 OAKVIEW TERRACE
JAMAICA PLAIN MA
02130
US

IV. Provider business mailing address

1516 BEACON ST
BROOKLINE MA
02446
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • 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
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8549
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: