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General NPI Number Information
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NPI Number | 1598457277
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Entity Type | Individual
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Provider Name | MR. ALEC GREGORY DEYERMENJIAN
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 233 NEEDHAM ST STE 300
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City | NEWTON
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State | MA
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Zip | 02464-1502
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Country | US
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Telephone | 617-830-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MEACHAM RD APT 1
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City | SOMERVILLE
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State | MA
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Zip | 02144-2732
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Country | US
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Telephone | 617-458-2335
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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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