Provider Demographics
NPI:1457704157
Name:BEZREH, MICHAEL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BEZREH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4828
Mailing Address - Country:US
Mailing Address - Phone:781-531-8188
Mailing Address - Fax:409-213-3005
Practice Address - Street 1:460 HILLSIDE AVE STE C
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1279
Practice Address - Country:US
Practice Address - Phone:781-531-8188
Practice Address - Fax:409-213-3005
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298928363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health