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General NPI Number Information
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NPI Number | 1669871232
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Entity Type | Individual
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Provider Name | KYRAH AUGMON-BOSSA LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 250 BRANDEGEE AVE
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City | GROTON
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State | CT
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Zip | 06340
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Country | US
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Telephone | 860-446-1775
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Fax | 860-446-2513
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Provider Business Mailing Address
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Address Line | 255 HEMPSTEAD ST
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City | NEW LONDON
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State | CT
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Zip | 06320-6204
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Country | US
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Telephone | 860-443-2896
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Fax | 860-442-5909
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW.002065
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License Number State | CT
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