Provider Demographics
NPI:1447980529
Name:DESERT, PATRICIA MURA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MURA
Last Name:DESERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1702
Mailing Address - Country:US
Mailing Address - Phone:617-356-8242
Mailing Address - Fax:
Practice Address - Street 1:1525 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1702
Practice Address - Country:US
Practice Address - Phone:617-356-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health