Provider Demographics
NPI:1023402641
Name:OTU-APPIAH, GEORGE (LMSW,MSW,BS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:OTU-APPIAH
Suffix:
Gender:M
Credentials:LMSW,MSW,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 COLT HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3076
Mailing Address - Country:US
Mailing Address - Phone:860-838-1738
Mailing Address - Fax:
Practice Address - Street 1:306 COLT HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3076
Practice Address - Country:US
Practice Address - Phone:860-838-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1002104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13528687OtherCAQH
CTPENDINGMedicaid