Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 11536 | MA |
NPI | 1679063200 |
---|---|
Provider Name | Romeissa Selmane |
First Address | Boston, MA 02109-3525 |
Second Address | Brighton, MA 02135-3601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |