Provider Demographics
NPI:1720628399
Name:FAGUNDO-OJEDA, DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:FAGUNDO-OJEDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 REPTON PL UNIT 1210
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2485
Mailing Address - Country:US
Mailing Address - Phone:787-560-4861
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 107
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-744-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY5000502103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical