Healthcare Provider Details

I. General information

NPI: 1720925118
Provider Name (Legal Business Name): JONES JOHNSON NYANSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROVE ST STE 119
WORCESTER MA
01605-2630
US

IV. Provider business mailing address

100 GROVE ST STE 119
WORCESTER MA
01605-2630
US

V. Phone/Fax

Practice location:
  • Phone: 774-420-2060
  • Fax: 774-530-6023
Mailing address:
  • Phone: 774-420-2060
  • Fax: 774-530-6023

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: