Provider Demographics
NPI:1982369336
Name:KROMAH, MAMADEE I
Entity Type:Individual
Prefix:
First Name:MAMADEE
Middle Name:
Last Name:KROMAH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 UPLAND GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1675
Mailing Address - Country:US
Mailing Address - Phone:508-335-1872
Mailing Address - Fax:
Practice Address - Street 1:9 UPLAND GARDEN DR APT 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1675
Practice Address - Country:US
Practice Address - Phone:508-335-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician