Provider Demographics
NPI:1508379835
Name:KOBI AMPEM, ABENAA
Entity Type:Individual
Prefix:
First Name:ABENAA
Middle Name:
Last Name:KOBI AMPEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:KYEI DONKOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 FALES ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2052
Mailing Address - Country:US
Mailing Address - Phone:617-991-5655
Mailing Address - Fax:
Practice Address - Street 1:277 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1207
Practice Address - Country:US
Practice Address - Phone:508-363-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician