Healthcare Provider Details

I. General information

NPI: 1033925631
Provider Name (Legal Business Name): ADDRISA ANKRAH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JOURNAL SQUARE SUITE 505
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

26 JOURNAL SQUARE SUITE 505
JERSEY CITY NJ
07306
US

V. Phone/Fax

Practice location:
  • Phone: 201-212-6475
  • Fax:
Mailing address:
  • Phone: 201-212-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06665700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: