Healthcare Provider Details

I. General information

NPI: 1487358222
Provider Name (Legal Business Name): IYINOLUWA OLUWATOLA LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PARK ST STE 310
MONTCLAIR NJ
07042-2960
US

IV. Provider business mailing address

2933 VAUXHALL RD STE 7
VAUXHALL NJ
07088-1248
US

V. Phone/Fax

Practice location:
  • Phone: 929-888-7956
  • Fax: 929-778-4356
Mailing address:
  • Phone: 929-888-7956
  • Fax: 929-788-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06577300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00396200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: