Provider Demographics
NPI:1346987641
Name:AMOAH-MENSAH, LETTICIA
Entity Type:Individual
Prefix:
First Name:LETTICIA
Middle Name:
Last Name:AMOAH-MENSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GLOUCESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8330
Mailing Address - Country:US
Mailing Address - Phone:610-507-1486
Mailing Address - Fax:
Practice Address - Street 1:119 GLOUCESTER BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8330
Practice Address - Country:US
Practice Address - Phone:610-507-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities