Healthcare Provider Details

I. General information

NPI: 1346950524
Provider Name (Legal Business Name): MR. UCHENNA KALU OGBAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

400 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax:
Mailing address:
  • Phone: 203-503-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12825
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: