MEDICARE: AGHAKU ANGEL UKPONAHUSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114876208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGHAKU ANGEL UKPONAHUSI

Provider Business Mailing Address
First Line	:	46 WILLIAM KELLEY RD
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-3077
Country	:	US
Telephone Number	:	857-308-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 WILLIAM KELLEY RD
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-3077
Country	:	US
Telephone Number	:	857-308-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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