MEDICARE: ABIMBOLA OMISORE AKEJU LCSW

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	1041C0700X	Clinical Social Worker	44SC05405600	NJ

General Provider Information

NPI Number	:	1558682062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIMBOLA OMISORE AKEJU LCSW

Provider Business Mailing Address
First Line	:	873 US ROUTE 1 # 1021
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3345
Country	:	US
Telephone Number	:	973-714-6586
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 US ROUTE 1 # 1021
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3345
Country	:	US
Telephone Number	:	973-714-6586
Fax Number	:

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/26/2024

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