Provider Demographics
NPI:1992381578
Name:AGUDELO, OSCAR DAVID
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:DAVID
Last Name:AGUDELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:D
Other - Last Name:AGUDELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 EUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2826
Mailing Address - Country:US
Mailing Address - Phone:617-913-8477
Mailing Address - Fax:
Practice Address - Street 1:245 EUSTIS ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2826
Practice Address - Country:US
Practice Address - Phone:617-913-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)