Provider Demographics
NPI:1548772528
Name:HANAFI, IMAN
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:HANAFI
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 1:650 HUNTINGTON AVE APT 6J
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5914
Mailing Address - Country:US
Mailing Address - Phone:617-396-6434
Mailing Address - Fax:
Practice Address - Street 1:1245 HANCOCK ST STE 25
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4365
Practice Address - Country:US
Practice Address - Phone:617-396-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC0008520700OtherBMC