Healthcare Provider Details

I. General information

NPI: 1679326508
Provider Name (Legal Business Name): SEYED VAHID HOSSEINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MYSTIC AVE
MEDFORD MA
02155-4632
US

IV. Provider business mailing address

90 HARRIET ST
BOSTON MA
02135-2143
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-1199
  • 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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: