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General NPI Number Information
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NPI Number | 1316625726
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Entity Type | Individual
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Provider Name | JERMAINE OWUSU
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Gender | Male
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 324 CLARK ST
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City | WORCESTER
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State | MA
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Zip | 01606-1214
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Country | US
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Telephone | 508-791-4976
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Fax |
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Provider Business Mailing Address
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Address Line | 161 COUNTRY CLUB BLVD APT 416
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City | WORCESTER
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State | MA
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Zip | 01605-1521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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