Basic Information
| Provider Information | |||||||||
| NPI: | 1528467677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DDAMULIRA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MAYANJA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 WEST ST | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018011822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812859050 | ||||||||
| FaxNumber: | 6176004728 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 WEST ST | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018011822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812859050 | ||||||||
| FaxNumber: | 6176004728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 001321890 | 01 | MA | TRANSPORTATION FOR MEDICAL PURPOSES | OTHER |