Provider Demographics
NPI:1366036725
Name:BA, BINTA BOBO
Entity Type:Individual
Prefix:
First Name:BINTA
Middle Name:BOBO
Last Name:BA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERS EDGE PL
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6340
Mailing Address - Country:US
Mailing Address - Phone:617-407-0986
Mailing Address - Fax:
Practice Address - Street 1:17 RIVERS EDGE PL
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6340
Practice Address - Country:US
Practice Address - Phone:617-407-0986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA542528020OtherPASSPORT