Healthcare Provider Details

I. General information

NPI: 1821889429
Provider Name (Legal Business Name): OLUWAFUNMIKE RUTH OLOMOFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COVE ST
FALL RIVER MA
02720-1357
US

IV. Provider business mailing address

126 COVE ST
FALL RIVER MA
02720-1357
US

V. Phone/Fax

Practice location:
  • Phone: 774-520-1783
  • Fax:
Mailing address:
  • Phone: 774-520-1783
  • 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 Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: