Healthcare Provider Details

I. General information

NPI: 1598017287
Provider Name (Legal Business Name): LATOYA OGUNBONA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CUMMINGS CTR 364 U
BEVERLY MA
01915-6175
US

IV. Provider business mailing address

10 FORBES RD
BRAINTREE MA
02184-2605
US

V. Phone/Fax

Practice location:
  • Phone: 978-427-0903
  • Fax:
Mailing address:
  • Phone: 978-427-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1120948
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: