Healthcare Provider Details

I. General information

NPI: 1568452092
Provider Name (Legal Business Name): BONNIE YOSHIKO OHYE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 LORING AVENUE
SALEM MA
01970
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-8504
  • Fax: 978-745-3529
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3174
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: