Healthcare Provider Details

I. General information

NPI: 1346796877
Provider Name (Legal Business Name): NEJLA SEZER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST STE 209
NORTHBOROUGH MA
01532-2132
US

IV. Provider business mailing address

23 BRIDLE RIDGE DR
NORTH GRAFTON MA
01536-2211
US

V. Phone/Fax

Practice location:
  • Phone: 774-312-5058
  • Fax:
Mailing address:
  • Phone: 774-813-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12256
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: