Provider Demographics
NPI:1285002691
Name:NDEGWA, PHILIP NDEGWA
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:NDEGWA
Last Name:NDEGWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ALLIED DR
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6122
Mailing Address - Country:US
Mailing Address - Phone:774-293-4354
Mailing Address - Fax:
Practice Address - Street 1:335 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3441
Practice Address - Country:US
Practice Address - Phone:508-753-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS41998915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor