MEDICARE: ADDRISA ANKRAH LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC06665700	NJ

General Provider Information

NPI Number	:	1033925631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDRISA ANKRAH LSW

Provider Business Mailing Address
First Line	:	26 JOURNAL SQUARE
Second Line	:	SUITE 505
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-212-6475
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 JOURNAL SQUARE
Second Line	:	SUITE 505
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-212-6475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	06/15/2026

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