Healthcare Provider Details

I. General information

NPI: 1245071398
Provider Name (Legal Business Name): SYONA MOORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HARTWELL AVE STE 310
LEXINGTON MA
02421-3177
US

IV. Provider business mailing address

104 CAMINO PENASCO
EL PASO TX
79912-3438
US

V. Phone/Fax

Practice location:
  • Phone: 781-918-6869
  • 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 StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: