MEDICARE: DR. OLABANJI ADENIRANYE PSY.D., LMFT

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	103T00000X	Psychologist	PSY31774	CA
2	103TP2701X	Group Psychotherapy Psychologist		CA
3	106H00000X	Marriage & Family Therapist		CA
4	103TB0200X	Cognitive & Behavioral Psychologist
5	103TC2200X	Clinical Child & Adolescent Psychologist
6	101Y00000X	Counselor
7	101YM0800X	Mental Health Counselor
8	103TC0700X	Clinical Psychologist	PSY31774	CA

General Provider Information

NPI Number	:	1033623996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLABANJI ADENIRANYE PSY.D., LMFT

Provider Business Mailing Address
First Line	:	2801 B ST # 2134
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2208
Country	:	US
Telephone Number	:	619-514-3320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 B ST # 2134
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2208
Country	:	US
Telephone Number	:	619-514-3320
Fax Number	:

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

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	11/06/2024

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