Provider Demographics
NPI:1669279899
Name:IDUMWONYI, OGHOGHO JOYCE
Entity type:Individual
Prefix:
First Name:OGHOGHO
Middle Name:JOYCE
Last Name:IDUMWONYI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3011
Mailing Address - Country:US
Mailing Address - Phone:617-487-2211
Mailing Address - Fax:617-830-9466
Practice Address - Street 1:186 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3011
Practice Address - Country:US
Practice Address - Phone:617-487-2211
Practice Address - Fax:617-830-9466
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical