Provider Demographics
NPI:1861221756
Name:GHORIESHI, BOBBY
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:GHORIESHI
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 1:4930 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2527
Mailing Address - Country:US
Mailing Address - Phone:781-386-7939
Mailing Address - Fax:
Practice Address - Street 1:3057 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3636
Practice Address - Country:US
Practice Address - Phone:508-961-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health