=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790893519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSEKRE INTERNATIONAL ENTERPRISE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 01/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4008 12TH STREET NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-309-5215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4008 12TH STREET NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-309-5215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MS. ADJELEY AMENG OSEKRE
-----------------------------------------------------
Credential | LCSWC LICSW
-----------------------------------------------------
Telephone | 203-309-5215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 09852
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LC302971
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------