Healthcare Provider Details

I. General information

NPI: 1023473584
Provider Name (Legal Business Name): AYOBAMI AKINDUMILA MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BEACON ST STE 120
BROOKLINE MA
02446-4816
US

IV. Provider business mailing address

3002 CECIL B MOORE AVE APT 34
PHILADELPHIA PA
19121-2532
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001174
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: