Healthcare Provider Details

I. General information

NPI: 1396507117
Provider Name (Legal Business Name): MUDITA JIJIVISHA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ATWOOD DR STE 301
NORTHAMPTON MA
01060-4266
US

IV. Provider business mailing address

8 ATWOOD DR STE 301
NORTHAMPTON MA
01060-4266
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-1314
  • Fax:
Mailing address:
  • Phone: 413-773-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: