Healthcare Provider Details

I. General information

NPI: 1285002691
Provider Name (Legal Business Name): PHILIP NDEGWA NDEGWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CHANDLER ST
WORCESTER MA
01602-3441
US

IV. Provider business mailing address

3 ALLIED DR
DEDHAM MA
02026-6122
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-2967
  • Fax:
Mailing address:
  • Phone: 774-293-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1810
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMHC12048
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014028
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: