Provider Demographics
NPI:1073374534
Name:SUBURBAN PSYCHIATRIC SPECIALISTS PC
Entity Type:Organization
Organization Name:SUBURBAN PSYCHIATRIC SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UJALA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-206-8578
Mailing Address - Street 1:1500 BOSTON PROVIDENCE TPKE STE 22B
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4649
Mailing Address - Country:US
Mailing Address - Phone:508-206-8578
Mailing Address - Fax:
Practice Address - Street 1:1500 BOSTON PROVIDENCE TPKE STE 22B
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4649
Practice Address - Country:US
Practice Address - Phone:508-206-8578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty