Healthcare Provider Details

I. General information

NPI: 1831256379
Provider Name (Legal Business Name): XENIA JOHNSON BHEMBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: XENIA JOHNSON BHEMBE

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 502
BROOKLINE MA
02445-7277
US

IV. Provider business mailing address

PO BOX 870261
MILTON VILLAGE MA
02187-0261
US

V. Phone/Fax

Practice location:
  • Phone: 617-690-2011
  • Fax: 888-312-9236
Mailing address:
  • Phone: 617-690-2011
  • Fax: 888-312-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number158221
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number158221
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: