Provider Demographics
NPI:1366283079
Name:BUNNA, ALFRED BOAFO (MHC-A)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:BOAFO
Last Name:BUNNA
Suffix:
Gender:M
Credentials:MHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SEVER ST APT 1001
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2164
Mailing Address - Country:US
Mailing Address - Phone:508-232-9866
Mailing Address - Fax:
Practice Address - Street 1:11 SEVER ST APT 1001
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2164
Practice Address - Country:US
Practice Address - Phone:508-232-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00187-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health