Healthcare Provider Details

I. General information

NPI: 1275401341
Provider Name (Legal Business Name): KENNETH OWUSU ANSAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

12 MOUNTAINSHIRE DR
WORCESTER MA
01606-2954
US

V. Phone/Fax

Practice location:
  • Phone: 508-454-1928
  • Fax:
Mailing address:
  • Phone: 682-401-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: