MEDICARE: RASON GHOLIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528302759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASON GHOLIAN

Provider Business Mailing Address
First Line	:	2115 E 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6317
Country	:	US
Telephone Number	:	443-415-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 E 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6317
Country	:	US
Telephone Number	:	443-415-7630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	03/17/2018

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