Healthcare Provider Details

I. General information

NPI: 1326749615
Provider Name (Legal Business Name): MAYOWA OBASAJU PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLUWAMAYOWA OBASAJU PHD

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 156TH ST APT 44
NEW YORK NY
10032-7706
US

IV. Provider business mailing address

501 W 156TH ST APT 44
NEW YORK NY
10032-7706
US

V. Phone/Fax

Practice location:
  • Phone: 516-654-7339
  • Fax:
Mailing address:
  • Phone: 516-654-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019045
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number019045
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number019045
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number019045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: