Healthcare Provider Details

I. General information

NPI: 1487754974
Provider Name (Legal Business Name): MOHAMAD AMJAD BAHNASSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMJAD BAHNASSI MD

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 06/16/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEHAVIORAL HEALTHCARE SERVICES 435 SHREWSBURY STREET
WORCESTER MA
01604-1689
US

IV. Provider business mailing address

435 SHREWSBURY STREET
WORCESTER MA
01604-1689
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-5554
  • Fax: 508-752-7245
Mailing address:
  • Phone: 508-753-5554
  • Fax: 508-752-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number59555
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59555
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: