Provider Demographics
NPI:1740076124
Name:OLAEMEK
Entity type:Organization
Organization Name:OLAEMEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:KEMEALO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSATCHA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-756-8310
Mailing Address - Street 1:44 SCHOOL ST STE 505
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4221
Mailing Address - Country:US
Mailing Address - Phone:857-206-1553
Mailing Address - Fax:
Practice Address - Street 1:32 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8019
Practice Address - Country:US
Practice Address - Phone:617-756-8310
Practice Address - Fax:617-756-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty