Healthcare Provider Details

I. General information

NPI: 1487418802
Provider Name (Legal Business Name): OLUWAFUNMIBI GANIAT YUSUFF LMHC-A, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 WATERMAN ST
PROVIDENCE RI
02906-4064
US

IV. Provider business mailing address

154 MAIN ST
WOONSOCKET RI
02895-4469
US

V. Phone/Fax

Practice location:
  • Phone: 401-400-2003
  • Fax:
Mailing address:
  • Phone: 401-999-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00165-A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: