Organization
MEDICAL COMMUNITY PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE OLUSOLA AKINKUOYE PMHNP-BC, DNP (PRESIDENT)
(508) 733-5951
Entity
Organization
Contact information
Practice address
264 UNION AVE APT 2, FRAMINGHAM, MA 01702-6348
(508) 733-5951
(508) 321-1960
Mailing address
264 UNION AVE APT 2, FRAMINGHAM, MA 01702-6348
(774) 244-4128
(774) 244-4129
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
233605
MA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110469A
—
MA
01
—
1366796088
COMMONWEALTH CARE ALLIANCE
MA
Enumeration date
08/16/2018
Last updated
01/08/2021
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