Provider Demographics
NPI:1891987376
Name:OSIME, OSILAMA (MS)
Entity Type:Individual
Prefix:
First Name:OSILAMA
Middle Name:
Last Name:OSIME
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WINTHROP PKWY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3727
Mailing Address - Country:US
Mailing Address - Phone:857-222-3220
Mailing Address - Fax:
Practice Address - Street 1:41 WINTHROP PKWY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3727
Practice Address - Country:US
Practice Address - Phone:857-222-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health