Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edwin Japheth Agbonavbare, CNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1386007631

Edwin Japheth Agbonavbare, CNP is a Nurse Practitioner in Peabody, Massachusetts. Qualified in 2019, 7 years ago. Practices with Supportive Behavioral Care of MA LLC, a 106-clinician group and accepts Medicare assignment. Licensed in Massachusetts and New York.

Years since qualifying
7
Licensed in
MA, NY
In the registry since
2016
Specialties on file
2
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

100 Corporate Pl Ste 303
Peabody, MA 01960-3809
Phone: (781) 640-1791
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence RN2277840 (MA)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 406565 (NY)

Record details

NPI number1386007631
Entity typeIndividual (Type 1)
GenderMale
Credentials CNP
Sole proprietorYes
NPI enumeratedApril 4, 2016
Last updated in NPPESDecember 10, 2024
Certification dateDecember 10, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Supportive Behavioral Care Of Ma Llc — 106 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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