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General NPI Number Information
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NPI Number | 1053761973
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Entity Type | Individual
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Provider Name | PHARA JEAN DENIS
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 504 DUDLEY ST
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City | ROXBURY
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State | MA
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Zip | 02119-2732
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Country | US
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Telephone | 617-445-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 39 WILLIAM ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-3833
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Country | US
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Telephone | 617-319-2021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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