Healthcare Provider Details

I. General information

NPI: 1275022550
Provider Name (Legal Business Name): OLUSOLA MOTUNRAYO ANARUWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH STREET
NORTHEAST DC
20118
US

IV. Provider business mailing address

3430 DODGE PARK ROAD APT 204
HYATTSVILLE MD
20785
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax: 202-832-8341
Mailing address:
  • Phone: 240-714-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: