Provider Demographics
NPI:1033565692
Name:MASHMASARMI, YASAMAN
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:MASHMASARMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1537
Mailing Address - Country:US
Mailing Address - Phone:617-959-9765
Mailing Address - Fax:
Practice Address - Street 1:946 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1537
Practice Address - Country:US
Practice Address - Phone:617-959-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker