=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497544308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OJEHEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 GLEN ST STE 2
-----------------------------------------------------
City | STOUGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02072-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-756-1470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 GLEN ST STE 2
-----------------------------------------------------
City | STOUGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02072-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC
-----------------------------------------------------
Name | ETHEL AKHIBI-IREO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-756-1701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------