Provider Demographics
NPI:1528467677
Name:DDAMULIRA, JOSEPH MAYANJA
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MAYANJA
Last Name:DDAMULIRA
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 1:11 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1822
Mailing Address - Country:US
Mailing Address - Phone:781-285-9050
Mailing Address - Fax:617-600-4728
Practice Address - Street 1:11 WEST ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1822
Practice Address - Country:US
Practice Address - Phone:781-285-9050
Practice Address - Fax:617-600-4728
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001321890OtherTRANSPORTATION FOR MEDICAL PURPOSES