Provider Demographics
NPI:1497296354
Name:RAMEZANY, CEPIDEH
Entity Type:Individual
Prefix:
First Name:CEPIDEH
Middle Name:
Last Name:RAMEZANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:RAMEZANY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:148 BROADWAY
Mailing Address - Street 2:UNIT 3
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3275
Mailing Address - Country:US
Mailing Address - Phone:408-508-0394
Mailing Address - Fax:
Practice Address - Street 1:148 BROADWAY
Practice Address - Street 2:UNIT 3
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3275
Practice Address - Country:US
Practice Address - Phone:408-508-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health