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General NPI Number Information
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NPI Number | 1386904910
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Entity Type | Individual
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Provider Name | OLABISI LEOLA TINE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 26 COURT ST SUITE 602
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 347-224-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 310 LENOX RD #6C
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City | BROOKLYN
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State | NY
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Zip | 11226-2274
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Country | US
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Telephone | 917-853-9766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 73079660
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License Number State | NY
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