Provider Demographics
NPI:1104322692
Name:APENA, KAOSARAT OLAMIDE OYINKANSOLA (LGSW)
Entity type:Individual
Prefix:
First Name:KAOSARAT
Middle Name:OLAMIDE OYINKANSOLA
Last Name:APENA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 MEANDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2217
Mailing Address - Country:US
Mailing Address - Phone:301-357-1169
Mailing Address - Fax:
Practice Address - Street 1:9701 PHILADELPHIA CT STE R
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4435
Practice Address - Country:US
Practice Address - Phone:443-438-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker