Healthcare Provider Details

I. General information

NPI: 1790412914
Provider Name (Legal Business Name): JENNIFER ENDAH MBAH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

30 WARREN ST
BRIGHTON MA
02135-3680
US

V. Phone/Fax

Practice location:
  • Phone: 781-292-2196
  • Fax:
Mailing address:
  • Phone: 617-254-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: