MEDICARE: TRACY OTUBU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2365786	MA

General Provider Information

NPI Number	:	1194516773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY OTUBU

Provider Business Mailing Address
First Line	:	867 BOYLSTON ST FL 5
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-2774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 RESERVOIR ST
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3169
Country	:	US
Telephone Number	:	877-920-6583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	01/13/2026

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Directions to “ TRACY OTUBU ” Practice Location

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