Provider Demographics
NPI:1740699032
Name:KAFUUMA, JUDE THADDEO (MED)
Entity type:Individual
Prefix:MR
First Name:JUDE
Middle Name:THADDEO
Last Name:KAFUUMA
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1823
Mailing Address - Country:US
Mailing Address - Phone:978-655-7782
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST STE 204
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1823
Practice Address - Country:US
Practice Address - Phone:978-655-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000023532OtherBMC
1004745OtherNHP
MA042611055OtherTAX ID
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA1303287OtherMBHP
MA1004745OtherNHP
MA1303287Medicaid