Healthcare Provider Details

I. General information

NPI: 1316675275
Provider Name (Legal Business Name): DATTA CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ROSALIE RD
NEWTON CENTER MA
02459-3153
US

IV. Provider business mailing address

132 ROSALIE RD
NEWTON CENTER MA
02459-3153
US

V. Phone/Fax

Practice location:
  • Phone: 617-548-0184
  • Fax: 617-609-7636
Mailing address:
  • Phone: 617-548-0184
  • Fax: 617-609-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DATTA GOURI
Title or Position: OWNER/PSYCHIATRIST
Credential: MD
Phone: 617-548-0184