1609752211 NPI number — ATREEF THERAPY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609752211 NPI number — ATREEF THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATREEF THERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609752211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 HARRISON AVE
Provider Second Line Business Mailing Address:
STE 605 PMB 866561
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-906-6767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LANDSDOWNE ST. APT. 1810
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-906-6767
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
SHABAHANG
Authorized Official First Name:
EHSAN
Authorized Official Middle Name:
ADIB
Authorized Official Title or Position:
OWNER AND LICENSED MENTAL HEALTH CO
Authorized Official Telephone Number:
617-906-6767

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720739824 . This is a "TYPE 1 NPI" identifier . This identifiers is of the category "OTHER".




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