Provider Information for 1578694410
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Ms. MOUSHUMI G GHOSE MFT
Sex: Female
NPI: 1578694410
Last Updated: 2023-04-19
Certification Date: 2023-04-19
Certification Date: 2023-04-19
Details
Name | Value | ||||||||||||
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NPI | 1578694410 | ||||||||||||
Enumeration Date | 2007-03-09 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 1625 N SUMNER ST PORTLAND, OR 97217-3745 United States Phone: 323-739-4250 | Fax:818-936-0593 | ||||||||||||
Primary Practice Address | 201 N BRAND BLVD UNIT 200 GLENDALE, CA 91203-3590 United States Phone: 323-397-4250 | Fax:818-936-0593 | ||||||||||||
Secondary Practice Address(es) | 1625 N SUMNER ST | ||||||||||||
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