Healthcare Provider Details

I. General information

NPI: 1205621497
Provider Name (Legal Business Name): EMMANUEL NKETIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 INNERBELT RD
SOMERVILLE MA
02143-4418
US

IV. Provider business mailing address

17 INNERBELT RD
SOMERVILLE MA
02143-4418
US

V. Phone/Fax

Practice location:
  • Phone: 857-225-0241
  • Fax: 617-629-0010
Mailing address:
  • Phone: 875-225-0241
  • Fax: 617-629-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: