Provider Demographics
NPI:1124327408
Name:RWEYEMAMU, JUSTINIAN B
Entity type:Individual
Prefix:
First Name:JUSTINIAN
Middle Name:B
Last Name:RWEYEMAMU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAPLE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1828
Mailing Address - Country:US
Mailing Address - Phone:413-285-8722
Mailing Address - Fax:413-285-8642
Practice Address - Street 1:155 MAPLE ST STE 207
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-285-8722
Practice Address - Fax:413-285-8642
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health