MEDICARE: ABENA ODE ADOM

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	11883201	NY

General Provider Information

NPI Number	:	1861197741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABENA ODE ADOM

Provider Business Mailing Address
First Line	:	1034 REGIONAL PARK DR # 8109
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-1117
Country	:	US
Telephone Number	:	347-636-6575
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 WOODLAND PARK DR APT 8109
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6174
Country	:	US
Telephone Number	:	347-636-6575
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “ ABENA ODE ADOM ” Practice Location

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