Provider Demographics
NPI:1164882924
Name:KHOUZAMI, FADY (MS)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:KHOUZAMI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLUEGRASS LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4263
Mailing Address - Country:US
Mailing Address - Phone:508-241-8140
Mailing Address - Fax:
Practice Address - Street 1:17 BLUEGRASS LN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-4263
Practice Address - Country:US
Practice Address - Phone:508-241-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA608103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst