Provider Demographics
NPI:1679622187
Name:MIZUNO, HIDE
Entity type:Individual
Prefix:
First Name:HIDE
Middle Name:
Last Name:MIZUNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HIDEAKI
Other - Middle Name:
Other - Last Name:MIZUNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:341 MARLBOROUGH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1725
Mailing Address - Country:US
Mailing Address - Phone:617-536-3832
Mailing Address - Fax:
Practice Address - Street 1:341 MARLBOROUGH ST APT 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-1725
Practice Address - Country:US
Practice Address - Phone:617-536-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health