Healthcare Provider Details

I. General information

NPI: 1760835680
Provider Name (Legal Business Name): OLUWAPEMILOLA OBARAYE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 LOGAN ST 1ST FLOOR
BROOKLYN NY
11208-3784
US

IV. Provider business mailing address

591 LOGAN ST 1ST FLOOR
BROOKLYN NY
11208-3784
US

V. Phone/Fax

Practice location:
  • Phone: 718-513-0597
  • Fax:
Mailing address:
  • Phone: 718-513-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081257-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: