Individual
JEDIAH AGYENIM-BOATENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
48 ELM ST, WORCESTER, MA 01609-2541
(508) 225-6634
Mailing address
1 GOOD HARBOR DR, WORCESTER, MA 01606-1188
(508) 713-5813
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
SA5391593
MA
Other
Enumeration date
04/10/2026
Last updated
04/10/2026
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