Provider Demographics
NPI:1467686915
Name:OKARA, EBI (EDD)
Entity Type:Individual
Prefix:
First Name:EBI
Middle Name:
Last Name:OKARA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3741
Mailing Address - Country:US
Mailing Address - Phone:781-963-1200
Mailing Address - Fax:781-963-1201
Practice Address - Street 1:490 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3741
Practice Address - Country:US
Practice Address - Phone:781-963-1200
Practice Address - Fax:781-963-1201
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical