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NPI Code Detail

MEDICARE: ANANSES WISDOM PSYCHIATRY PLLC

MEDICARE: ANANSES WISDOM PSYCHIATRY PLLC
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
12084P0800XPsychiatry Physician
22084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1124877931
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANANSES WISDOM PSYCHIATRY PLLC
Provider Business Mailing Address
First Line : 2 GRANITE AVE STE 260
Second Line :
City : MILTON
State : MA
Zip : 02186-4381
Country : US
Telephone Number : 617-615-9702
Fax Number :
Provider Business Practice Location Address
First Line : 2 GRANITE AVE STE 260
Second Line :
City : MILTON
State : MA
Zip : 02186-4381
Country : US
Telephone Number : 617-615-9702
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MICAELA OWUSU
Credential : MD
Telephone Number : 617-615-9702
Provider Enumeration Date : 05/14/2024
Last Update Date : 05/14/2024

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Directions to “ANANSES WISDOM PSYCHIATRY PLLC ” Practice Location

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