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NPI Code Detail

MEDICARE: LATEEF AKEREDOLU CASAC-T

MEDICARE: LATEEF AKEREDOLU CASAC-T
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1659998045
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATEEF AKEREDOLU CASAC-T
Provider Business Mailing Address
First Line : 37 ARCADIA PL APT 1C
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10310-2273
Country : US
Telephone Number : 917-756-7621
Fax Number :
Provider Business Practice Location Address
First Line : 1268 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-2312
Country : US
Telephone Number : 718-981-8117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2020
Last Update Date : 07/01/2020

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