Healthcare Provider Details

I. General information

NPI: 1306987706
Provider Name (Legal Business Name): ADEMOLA MAROOF OWODUNNI MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PINE ST
PHILADELPHIA PA
19107-5945
US

IV. Provider business mailing address

12142 ASTER RD
PHILADELPHIA PA
19154-1702
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-9379
  • Fax:
Mailing address:
  • Phone: 215-637-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: