Provider Demographics
NPI:1689830994
Name:UMEH, BONIFACE I (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BONIFACE
Middle Name:I
Last Name:UMEH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JAMES TIGHE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2836
Mailing Address - Country:US
Mailing Address - Phone:617-710-4766
Mailing Address - Fax:
Practice Address - Street 1:5 JAMES TIGHE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2836
Practice Address - Country:US
Practice Address - Phone:617-710-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health