Provider Demographics
NPI:1427273697
Name:MOVAHEDI, SIAMAK (CERTIFIED PSYCHOANAL)
Entity type:Individual
Prefix:DR
First Name:SIAMAK
Middle Name:
Last Name:MOVAHEDI
Suffix:
Gender:M
Credentials:CERTIFIED PSYCHOANAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WABAN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2108
Mailing Address - Country:US
Mailing Address - Phone:617-332-3149
Mailing Address - Fax:617-287-6288
Practice Address - Street 1:252 WABAN AVE
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-2108
Practice Address - Country:US
Practice Address - Phone:617-332-3149
Practice Address - Fax:617-287-6288
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3297101YM0800X
NY000199102L00000X
VT098-0000005102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst