Healthcare Provider Details

I. General information

NPI: 1760207856
Provider Name (Legal Business Name): MR. OBINNA C OKORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 FOREST VIEW DR
AVENEL NJ
07001-2179
US

IV. Provider business mailing address

916 FOREST VIEW DR
AVENEL NJ
07001-2179
US

V. Phone/Fax

Practice location:
  • Phone: 917-868-3625
  • Fax:
Mailing address:
  • Phone: 917-868-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: