MEDICARE: MR. ISAAC ABIOYE OLASUPO MSC

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	103TB0200X	Cognitive & Behavioral Psychologist	408449700, 409426300	MD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		MD
3	101YM0800X	Mental Health Counselor		MD
4	103TR0400X	Rehabilitation Psychologist		MD

General Provider Information

NPI Number	:	1669405270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISAAC ABIOYE OLASUPO MSC

Provider Business Mailing Address
First Line	:	6510 JODIE ST
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3636
Country	:	US
Telephone Number	:	301-345-4787
Fax Number	:	301-345-5310

Provider Business Practice Location Address
First Line	:	2116 N CHARLES ST
Second Line	:	SUIT 300
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5758
Country	:	US
Telephone Number	:	410-244-0331
Fax Number	:	410-244-7364

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/11/2025

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