Individual ProviderAli WantimbaCounselorBehavioral Health & Social Service ProvidersPractice Address520 Dudley St, Roxbury, MA 02119-2769(781) 885-4264PECOS EnrollmentBased on the most recent information from CMS, provider Ali Wantimba does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1053102434Provider TypeIndividualFull NameWantimba, AliGenderMaleSole ProprietorYesEnumeration Date5/14/2025Last Updated5/14/2025Contact InformationPractice LocationPractice Address520 Dudley St, Roxbury, MA 02119-2769Phone(781) 885-4264FaxUnlisted FaxMailing LocationMailing Address504 Dudley St, Roxbury, MA 02119-2732PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer