Healthcare Provider Details

I. General information

NPI: 1912897786
Provider Name (Legal Business Name): MATILDA OWUSU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD DUPONT RD STE A
WILMINGTON DE
19804-1084
US

IV. Provider business mailing address

301 OLD DUPONT RD
WILMINGTON DE
19804-1000
US

V. Phone/Fax

Practice location:
  • Phone: 302-503-2273
  • Fax:
Mailing address:
  • Phone: 302-503-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0010913
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: