Provider Demographics
NPI:1114777612
Name:ESSIEN, BERNICE AGYEIWAA (CT)
Entity Type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:AGYEIWAA
Last Name:ESSIEN
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NORTH POTOMAC STREET, HAGERSTOWN MARYLAND 21740
Mailing Address - Street 2:
Mailing Address - City:MARYLAND, HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:240-420-1850
Mailing Address - Fax:
Practice Address - Street 1:714 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6010
Practice Address - Country:US
Practice Address - Phone:541-880-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORQMHP-R-1397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health