Provider Demographics
NPI:1457169633
Name:FAHARI PSYCHIATRIC AND MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:FAHARI PSYCHIATRIC AND MENTAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYGORETTI
Authorized Official - Middle Name:WAIRIMU
Authorized Official - Last Name:KIBE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:774-623-1241
Mailing Address - Street 1:352 W BOYLSTON ST STE 233
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2342
Mailing Address - Country:US
Mailing Address - Phone:774-623-1241
Mailing Address - Fax:
Practice Address - Street 1:352 W BOYLSTON ST STE 233
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2342
Practice Address - Country:US
Practice Address - Phone:774-623-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)