Provider Demographics
NPI:1598019044
Name:MENSAH, BERTHA
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:
Last Name: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 1:1775 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8205
Mailing Address - Country:US
Mailing Address - Phone:718-733-6100
Mailing Address - Fax:718-329-2056
Practice Address - Street 1:1775 GRAND CONCOURSE
Practice Address - Street 2:SUITE 701
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8205
Practice Address - Country:US
Practice Address - Phone:718-733-6100
Practice Address - Fax:718-329-2056
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator