Provider Demographics
NPI:1902265523
Name:TEHRANI, MOHSEN
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:TEHRANI
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 1:5 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3411
Mailing Address - Country:US
Mailing Address - Phone:857-399-6195
Mailing Address - Fax:
Practice Address - Street 1:5 SPRING ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3411
Practice Address - Country:US
Practice Address - Phone:857-399-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA811421091171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator