Provider Demographics
NPI:1265591648
Name:HOSSEINI-GHOMI, MARYAM (MED, LMHC)
Entity type:Individual
Prefix:MS
First Name:MARYAM
Middle Name:
Last Name:HOSSEINI-GHOMI
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:781-725-2777
Mailing Address - Fax:508-297-8222
Practice Address - Street 1:15 LILAC LN
Practice Address - Street 2:
Practice Address - City:NO EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356
Practice Address - Country:US
Practice Address - Phone:781-725-2777
Practice Address - Fax:508-297-8222
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA450727101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool