Healthcare Provider Details

I. General information

NPI: 1386259919
Provider Name (Legal Business Name): HIRA GHAFFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CEDAR HILL ST STE 200
MARLBOROUGH MA
01752-5900
US

IV. Provider business mailing address

36 HIGHLAND GLEN DR
RANDOLPH MA
02368-3912
US

V. Phone/Fax

Practice location:
  • Phone: 888-329-4535
  • Fax:
Mailing address:
  • Phone: 774-216-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: