MEDICARE: MRS. CARISA LORETTA OYEBANJO I LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC2302	MD

General Provider Information

NPI Number	:	1376660902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARISA LORETTA OYEBANJO I LCPC

Provider Business Mailing Address
First Line	:	12027 SWALLOW FALLS CT
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7814
Country	:	US
Telephone Number	:	301-572-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	12027 SWALLOW FALLS CT
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7814
Country	:	US
Telephone Number	:	301-572-8168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/24/2023

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