Healthcare Provider Details

I. General information

NPI: 1902006653
Provider Name (Legal Business Name): BOKUN A OGBEBOR M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 LEGATE HILL RD
LEOMINSTER MA
01453-5237
US

IV. Provider business mailing address

232 LEGATE HILL RD
LEOMINSTER MA
01453-5237
US

V. Phone/Fax

Practice location:
  • Phone: 781-632-3099
  • Fax:
Mailing address:
  • Phone: 781-632-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: