Provider Demographics
NPI:1407516149
Name:BOAFO, WILLIAM KWAME (PMHNP DNP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KWAME
Last Name:BOAFO
Suffix:
Gender:M
Credentials:PMHNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5760
Mailing Address - Country:US
Mailing Address - Phone:860-308-3888
Mailing Address - Fax:
Practice Address - Street 1:9 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5760
Practice Address - Country:US
Practice Address - Phone:860-308-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health