Provider Demographics
NPI:1659495323
Name:EBRAHIMI-KESHISHIAN, SEDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEDA
Middle Name:
Last Name:EBRAHIMI-KESHISHIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BOW ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5103
Mailing Address - Country:US
Mailing Address - Phone:617-547-2255
Mailing Address - Fax:617-547-0003
Practice Address - Street 1:3 BOW ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5103
Practice Address - Country:US
Practice Address - Phone:617-547-2255
Practice Address - Fax:617-547-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical