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General NPI Number Information
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NPI Number | 1972211027
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Entity Type | Individual
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Provider Name | EDMOND OPPONG MSW
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Gender | Male
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 29 MAIN ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-5546
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Country | US
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Telephone | 978-786-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 104 UPLAND ST
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City | WORCESTER
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State | MA
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Zip | 01607-1811
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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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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW229113
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License Number State | MA
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