Healthcare Provider Details

I. General information

NPI: 1033881867
Provider Name (Legal Business Name): PAULINE PATIENCE KPANNAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SYCAMORE ST
WORCESTER MA
01608-2213
US

IV. Provider business mailing address

11 SYCAMORE ST
WORCESTER MA
01608-2213
US

V. Phone/Fax

Practice location:
  • Phone: 508-798-1900
  • Fax: 508-798-1914
Mailing address:
  • Phone: 508-798-1900
  • Fax: 508-798-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: