Healthcare Provider Details

I. General information

NPI: 1528954070
Provider Name (Legal Business Name): NORYOR TORITSEJU OMATSEYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GWYNNSWOOD RD
OWINGS MILLS MD
21117-1767
US

IV. Provider business mailing address

64 GWYNNSWOOD RD
OWINGS MILLS MD
21117-1767
US

V. Phone/Fax

Practice location:
  • Phone: 862-763-3548
  • Fax:
Mailing address:
  • Phone: 862-763-3548
  • Fax: 862-763-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: