Healthcare Provider Details

I. General information

NPI: 1780741736
Provider Name (Legal Business Name): IMANI ZARA SEUNARINE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 TEMPLE ST 2ND FLOOR
QUINCY MA
02169-5110
US

IV. Provider business mailing address

13 TEMPLE ST 2ND FLOOR
QUINCY MA
02169-5110
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax: 617-845-9255
Mailing address:
  • Phone: 617-471-8400
  • Fax: 617-845-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: