Provider Demographics
NPI:1760609549
Name:S. EBRAHIMI-KESHISHIAN, PH.D., PC
Entity Type:Organization
Organization Name:S. EBRAHIMI-KESHISHIAN, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMI-KESHISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-547-8764
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:617-547-8764
Mailing Address - Fax:
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:617-547-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty