Provider Demographics
NPI:1063152965
Name:OLOJUGBA, SAMUEL BIDEMI (RBT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BIDEMI
Last Name:OLOJUGBA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 DENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5806
Mailing Address - Country:US
Mailing Address - Phone:410-301-9718
Mailing Address - Fax:
Practice Address - Street 1:5017 DENMORE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5806
Practice Address - Country:US
Practice Address - Phone:410-301-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-196435106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty