Provider Demographics
NPI:1275942609
Name:BOAMAH, DANIEL AGYEI (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:AGYEI
Last Name:BOAMAH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51372
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5672
Mailing Address - Country:US
Mailing Address - Phone:270-938-1020
Mailing Address - Fax:270-938-1018
Practice Address - Street 1:2815 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3960
Practice Address - Country:US
Practice Address - Phone:270-938-1020
Practice Address - Fax:270-938-1018
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3917104100000X, 171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100306270Medicaid