Provider Demographics
NPI:1568163780
Name:NKWANTAH, MARTINA NGONGA I
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:NGONGA
Last Name:NKWANTAH
Suffix:I
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 1:34 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033-2008
Mailing Address - Country:US
Mailing Address - Phone:978-512-1851
Mailing Address - Fax:
Practice Address - Street 1:34 PARKER RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:NH
Practice Address - Zip Code:03033-2008
Practice Address - Country:US
Practice Address - Phone:978-512-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst