Provider Demographics
NPI:1043715881
Name:MEHDI, SHERIF GHASSAN
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:GHASSAN
Last Name:MEHDI
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 1:6 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3216
Mailing Address - Country:US
Mailing Address - Phone:617-990-6108
Mailing Address - Fax:
Practice Address - Street 1:6 OAK ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3216
Practice Address - Country:US
Practice Address - Phone:617-990-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician