MEDICARE: MISS ELNAZ JAMALI AFOUSI

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	:	1669621686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELNAZ JAMALI AFOUSI

Provider Business Mailing Address
First Line	:	75 SAINT ALPHONSUS ST
Second Line	:	APT# 212
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-1676
Country	:	US
Telephone Number	:	857-204-0774
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 LAFAYETTE ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-4815
Country	:	US
Telephone Number	:	978-744-4033
Fax Number	:

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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