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General NPI Number Information
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NPI Number | 1639420813
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Entity Type | Individual
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Provider Name | MOHAMED ALI FARAH
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Gender | Male
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 520 DUDLEY ST
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City | ROXBURY
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State | MA
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Zip | 02119-2769
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Country | US
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Telephone | 617-989-9499
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Fax | 617-445-2672
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Provider Business Mailing Address
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Address Line | 11 BLACKWOOD ST 44
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City | BOSTON
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State | MA
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Zip | 02115-5151
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Country | US
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Telephone | 617-368-0473
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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