Provider Demographics
NPI:1760151658
Name:NAKANWAGI, SEERA FREDA NAMATOVU JR
Entity Type:Individual
Prefix:MS
First Name:SEERA
Middle Name:FREDA NAMATOVU
Last Name:NAKANWAGI
Suffix:JR
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SEERA
Other - Middle Name:FREDA NAMATOVU
Other - Last Name:NAKANWAGI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:978-682-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health