Healthcare Provider Details

I. General information

NPI: 1073374534
Provider Name (Legal Business Name): SUBURBAN PSYCHIATRIC SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BOSTON PROVIDENCE TPKE STE 20
NORWOOD MA
02062-4649
US

IV. Provider business mailing address

1500 BOSTON PROVIDENCE TPKE STE 20
NORWOOD MA
02062-4649
US

V. Phone/Fax

Practice location:
  • Phone: 508-206-8578
  • Fax:
Mailing address:
  • Phone: 508-206-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: UJALA FAWAD
Title or Position: PRESIDENT
Credential: MD
Phone: 508-206-8578