Provider Demographics
NPI:1316566581
Name:MEZIDOR, GARAPHA
Entity Type:Individual
Prefix:
First Name:GARAPHA
Middle Name:
Last Name:MEZIDOR
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 1:63 HARLEY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1750
Mailing Address - Country:US
Mailing Address - Phone:561-703-3044
Mailing Address - Fax:
Practice Address - Street 1:2 MASTER DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3052
Practice Address - Country:US
Practice Address - Phone:617-360-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health