Healthcare Provider Details

I. General information

NPI: 1053229690
Provider Name (Legal Business Name): ANISSA ADWOA AGYEI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 WASHINGSTON ST
AUBURN MA
01501
US

IV. Provider business mailing address

231 WEATHERSTONE DR
WORCESTER MA
01604-2664
US

V. Phone/Fax

Practice location:
  • Phone: 508-297-9728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: