Healthcare Provider Details

I. General information

NPI: 1720460512
Provider Name (Legal Business Name): JULIET N KULUBYA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 LEXINGTON ST # 10
WOBURN MA
01801-5945
US

IV. Provider business mailing address

241 LEXINGTON ST # 10
WOBURN MA
01801-5945
US

V. Phone/Fax

Practice location:
  • Phone: 617-610-4126
  • Fax:
Mailing address:
  • Phone: 617-610-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIET NANKINGA KULUBYA
Title or Position: FAMILY COUNSELLOR
Credential: MENTAL HEALTH
Phone: 617-610-4126