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General NPI Number Information
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NPI Number | 1447104310
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Entity Type | Organization
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Legal Business Name | BENEATH THE ICEBERG LLC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 19 6TH RD STE 1
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City | WOBURN
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State | MA
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Zip | 01801-1761
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Country | US
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Telephone | 617-971-8727
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Fax |
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Provider Business Mailing Address
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Address Line | 230 INDEPENDENCE WAY STE 1
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City | DANVERS
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State | MA
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Zip | 01923-3692
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Country | US
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Telephone | 617-971-8727
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Fax |
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Authorized Official
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Title or Position | FORENSIC CLINICIAN
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Name | DR. ESRAA AMIRA
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Credential | PSYD, LMHC, LCPC
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Telephone | 339-227-2939
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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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