Healthcare Provider Details

I. General information

NPI: 1902724297
Provider Name (Legal Business Name): VAJID PATHAN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 GROVE ST
WORCESTER MA
01605-1223
US

IV. Provider business mailing address

92 N MAIN ST APT A330
WEST BOYLSTON MA
01583-1152
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-3677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: