Provider Demographics
NPI:1801779749
Name:MWANJE, RAYMOND (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MWANJE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 WASHINGTON ST # 1050
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2115
Mailing Address - Country:US
Mailing Address - Phone:781-488-7406
Mailing Address - Fax:781-758-5377
Practice Address - Street 1:90 CANAL ST STE 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2022
Practice Address - Country:US
Practice Address - Phone:315-873-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health