Provider Demographics
NPI:1609947613
Name:MANIEI, FARAHNAZ (EDD)
Entity type:Individual
Prefix:DR
First Name:FARAHNAZ
Middle Name:
Last Name:MANIEI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1930
Mailing Address - Country:US
Mailing Address - Phone:617-730-9500
Mailing Address - Fax:617-437-9440
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:SUITE 404
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1930
Practice Address - Country:US
Practice Address - Phone:617-730-9500
Practice Address - Fax:617-437-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04501Medicare ID - Type UnspecifiedPSYCHOLOGIST