MEDICARE: DR. EHSAN ADIB SHABAHANG PHD, LMHC, NCC

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	101Y00000X	Counselor	88146	TX
2	101Y00000X	Counselor	6401224763	MI
3	101Y00000X	Counselor	20487	NC
4	101Y00000X	Counselor	10003605	MA
5	101Y00000X	Counselor	10501	SC

General Provider Information

NPI Number	:	1720739824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHSAN ADIB SHABAHANG PHD, LMHC, NCC

Provider Business Mailing Address
First Line	:	68 HARRISON AVE
Second Line	:	STE 605 PMB 866561
City	:	BOSTON
State	:	MA
Zip	:	02111-1929
Country	:	US
Telephone Number	:	832-850-1283
Fax Number	:	617-693-6040

Provider Business Practice Location Address
First Line	:	100 LANDSDOWNE ST APT 1810
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-4247
Country	:	US
Telephone Number	:	617-906-6767
Fax Number	:	617-693-6040

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

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	06/17/2026

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