Provider Demographics
NPI:1992313340
Name:GOSAI, SHIVAM KAMLESH
Entity type:Individual
Prefix:MR
First Name:SHIVAM
Middle Name:KAMLESH
Last Name:GOSAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 2ND ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1398
Mailing Address - Country:US
Mailing Address - Phone:724-825-0210
Mailing Address - Fax:
Practice Address - Street 1:670R MASSACHUSETTS AV/
Practice Address - Street 2:WHITTEMORE ROBBINS HOUSE
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476
Practice Address - Country:US
Practice Address - Phone:781-316-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty