MEDICARE: OPEYEMI FADAHUNSI 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	104100000X	Social Worker	1064961	NY
2	1041C0700X	Clinical Social Worker	099827

General Provider Information

NPI Number	:	1689230666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OPEYEMI FADAHUNSI LCSW

Provider Business Mailing Address
First Line	:	1159 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4527
Country	:	US
Telephone Number	:	347-447-7813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4527
Country	:	US
Telephone Number	:	646-528-3109
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	03/20/2025

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