Basic Information
| Provider Information | |||||||||
| NPI: | 1922040666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABOU-ALLABAN | ||||||||
| FirstName: | YOUSEF | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 80051 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 3150674 | 05 | MA | MEDICAID |