=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275783938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOYIN F AJASIN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2008
-----------------------------------------------------
Last Update Date | 12/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 WATERS PL
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10461-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-810-7595
-----------------------------------------------------
Fax | 718-810-7595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 TILDEN ST #9H
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-6026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-810-7595
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 079802
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------