Healthcare Provider Details

I. General information

NPI: 1568268332
Provider Name (Legal Business Name): HAZUKI OKAMOTO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HANCOCK ST STE 306
QUINCY MA
02169-5244
US

IV. Provider business mailing address

1515 HANCOCK ST STE 306
QUINCY MA
02169-5244
US

V. Phone/Fax

Practice location:
  • Phone: 617-404-3621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: