Healthcare Provider Details

I. General information

NPI: 1407556038
Provider Name (Legal Business Name): BRENDA KOBUSINGYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MOODY ST
WALTHAM MA
02453-5148
US

IV. Provider business mailing address

45 LOWER WESTFIELD RD
HOLYOKE MA
01040-2747
US

V. Phone/Fax

Practice location:
  • Phone: 857-318-3968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2325391
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2325391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: