Healthcare Provider Details

I. General information

NPI: 1144895046
Provider Name (Legal Business Name): BABATUNDE AIDEYAN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 EVERETT AVE
CHELSEA MA
02150-1812
US

IV. Provider business mailing address

360 HUNTINGTON AVE
BOSTON MA
02115-5005
US

V. Phone/Fax

Practice location:
  • Phone: 617-884-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001226
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY10001226
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10001226
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: