Provider Demographics
NPI:1730978719
Name:ONIAGBA, HERTELLE DORINE
Entity type:Individual
Prefix:
First Name:HERTELLE
Middle Name:DORINE
Last Name:ONIAGBA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAYSTACK LANE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779
Mailing Address - Country:US
Mailing Address - Phone:781-521-8664
Mailing Address - Fax:
Practice Address - Street 1:1 HAYSTACK LANE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779
Practice Address - Country:US
Practice Address - Phone:781-521-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency