=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083203046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OTASOWIE LILLIAN OSAIGBOVO LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2021
-----------------------------------------------------
Last Update Date | 01/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 E 169TH ST APT 2B
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10456-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-465-2964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 E 169TH ST APT 2B
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10456-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-465-2964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 111352
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------