Healthcare Provider Details

I. General information

NPI: 1891181426
Provider Name (Legal Business Name): COMFORT NYESWAH-WIAFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date: 12/04/2020
Reactivation Date: 05/13/2021

III. Provider practice location address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

IV. Provider business mailing address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax: 617-376-8910
Mailing address:
  • Phone: 617-471-8400
  • Fax: 617-376-8910

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: