Healthcare Provider Details

I. General information

NPI: 1568306892
Provider Name (Legal Business Name): NAOMI NKECHINYERE OKAFOR SR. JJDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA NKECHINYERE OKAFOR SR. JJDS

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BEAVER ST
BOSTON MA
02136-1714
US

IV. Provider business mailing address

115 BEAVER ST
BOSTON MA
02136-1714
US

V. Phone/Fax

Practice location:
  • Phone: 857-230-2729
  • Fax:
Mailing address:
  • Phone: 857-230-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number1568306892
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1568306892
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1568306892
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1568306892
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1568306892
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: