Basic Information
Provider Information
NPI: 1629566369
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALROQI
FirstName: FAISAL
MiddleName: TURKI
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 417 LIBERTY STREET
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011043736
CountryCode: US
TelephoneNumber: 4137470705
FaxNumber: 4137327075
Practice Location
Address1: 417 LIBERTY STREET
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011043736
CountryCode: US
TelephoneNumber: 4137363668
FaxNumber: 4137318651
Other Information
ProviderEnumerationDate: 04/27/2018
LastUpdateDate: 04/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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