Provider Demographics
NPI:1841172632
Name:TUFFAHA, BASSEL THAIER
Entity type:Individual
Prefix:
First Name:BASSEL
Middle Name:THAIER
Last Name:TUFFAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GROVER ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1900
Mailing Address - Country:US
Mailing Address - Phone:617-650-7545
Mailing Address - Fax:
Practice Address - Street 1:450 BEDFORD ST STE 2400
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1544
Practice Address - Country:US
Practice Address - Phone:781-633-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical