Healthcare Provider Details

I. General information

NPI: 1407653595
Provider Name (Legal Business Name): LYLA BAKHIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST STE 106
NATICK MA
01760-7700
US

IV. Provider business mailing address

67 UNION ST STE 106
NATICK MA
01760-7700
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax:
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2314624
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2314624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: