Provider Demographics
NPI:1124707187
Name:YUSUF, DAMILOLA FATIMAT I
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:FATIMAT
Last Name:YUSUF
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 PALAMAR TURN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2152
Mailing Address - Country:US
Mailing Address - Phone:615-839-0791
Mailing Address - Fax:
Practice Address - Street 1:7007 PALAMAR TURN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2152
Practice Address - Country:US
Practice Address - Phone:615-839-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician