Provider Demographics
NPI:1255895033
Name:OFORI AGYEMNAG, NANA YAW
Entity type:Individual
Prefix:
First Name:NANA
Middle Name:YAW
Last Name:OFORI AGYEMNAG
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 1:199 ROSEWOOD DR STE 250
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1684
Mailing Address - Country:US
Mailing Address - Phone:978-968-1700
Mailing Address - Fax:
Practice Address - Street 1:26 PARKRIDGE RD STE 2B
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8515
Practice Address - Country:US
Practice Address - Phone:978-373-3086
Practice Address - Fax:978-372-1341
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health