Olufunso Tosin Bamiduro
Individual provider Active NPI Mental Health Counselor · Roxbury, MA
NPI 1114574282 · NPPES record last updated Aug 22, 2019
Key facts
- NPI
- 1114574282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 520 Dudley St
Roxbury, MA 02119-2769 - Phone
- (617) 989-9499
- NPI assigned
- Aug 22, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
520 Dudley St
Roxbury, MA 02119-2769
Mailing address
520 Dudley St
Roxbury, MA 02119-2769
Phone (617) 989-9499
Other providers in Roxbury, MA
- Magdy Sami Badereldin
- Alicia Baez
- Furkan Bahar
- Juanita Baker
- Melanie Ann Baker
- Emma Banevicius
- Kianna Barbosa
- Nelseen Barbosa
- Novelet Barclay-Wint
- Patrick Barosy
All providers in Roxbury, MA · Mental Health Counselor in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.