1265591648 NPI number — MS. MARYAM HOSSEINI-GHOMI M.ED, LMHC

Table of content: MS. MARYAM HOSSEINI-GHOMI M.ED, LMHC (NPI 1265591648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265591648 NPI number — MS. MARYAM HOSSEINI-GHOMI M.ED, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOSSEINI-GHOMI
Provider First Name:
MARYAM
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LMHC
Provider Gender Code:
F

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:
1265591648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-725-2777
Provider Business Mailing Address Fax Number:
508-297-8222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LILAC LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NO EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-725-2777
Provider Business Practice Location Address Fax Number:
508-297-8222
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X , with the licence number:  450727 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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