Healthcare Provider Details

I. General information

NPI: 1396148961
Provider Name (Legal Business Name): LATIFA BUXAMUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 321
BROOKLINE MA
02445-7237
US

IV. Provider business mailing address

38 BONAIR ST APT 4
SOMERVILLE MA
02145-3158
US

V. Phone/Fax

Practice location:
  • Phone: 617-851-6781
  • Fax:
Mailing address:
  • Phone: 617-851-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: