=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609752211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATREEF THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 LANDSDOWNE ST. APT. 1810
-----------------------------------------------------
City | CAMBIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-906-6767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68 HARRISON AVE STE 605 PMB 866561
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-906-6767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND LICENSED MENTAL HEALTH CO
-----------------------------------------------------
Name | MR. EHSAN ADIB SHABAHANG
-----------------------------------------------------
Credential | MA, LCMHC
-----------------------------------------------------
Telephone | 617-906-6767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------