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General NPI Number Information
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NPI Number | 1841997889
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Entity Type | Individual
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Provider Name | MR. OBRAIN U AGWANIHU
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Gender | Male
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 09/08/2024
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Provider Practice Location Address
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Address Line | 622 DAVIS ST STE 200
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City | EVANSTON
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State | IL
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Zip | 60201-4491
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Country | US
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Telephone | 773-294-0176
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Fax |
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Provider Business Mailing Address
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Address Line | 128 BIXLEY HEATH
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City | LYNBROOK
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State | NY
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Zip | 11563-3140
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Country | US
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Telephone | 516-574-1018
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.110303
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.027628
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License Number State | IL
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