Healthcare Provider Details

I. General information

NPI: 1710491923
Provider Name (Legal Business Name): SAMAN BERENJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PRISCILLA RD UNIT 3
BOSTON VA
02135-2019
US

IV. Provider business mailing address

70 EVERETT AVE STE 515
CHELSEA MA
02150-2363
US

V. Phone/Fax

Practice location:
  • Phone: 202-740-2273
  • Fax: 202-740-2273
Mailing address:
  • Phone: 617-466-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: