Myriad R. Khorasani, LICSW
Social Worker, Clinical in Boston, MA. Individual provider (NPI-1).
NPI number1699043232
StatusActive
Last updated in NPPESJan 28, 2019
Details
- NPI
- 1699043232
- Entity type
- Individual (NPI-1)
- Name
- Myriad R. Khorasani
- Credential
- LICSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 10, 2011
- Last updated
- Jan 28, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 121162 | MA | Yes |
| 1041C0700X | Social Worker, Clinical | 084611-1 | NY |
Practice location
75 Francis StBoston, MA 02115-6110
Phone 617-732-5500
Mailing address
375 Boylston StBrookline, MA 02445-6007
Fax 857-307-0897
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