Provider Demographics
NPI:1154623395
Name:NNAJI, THEODORE MORGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MORGAN
Last Name:NNAJI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 E CIRCLE DR
Mailing Address - Street 2:# 186
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8638
Mailing Address - Country:US
Mailing Address - Phone:301-475-8860
Mailing Address - Fax:301-609-9091
Practice Address - Street 1:7711 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2322
Practice Address - Country:US
Practice Address - Phone:937-304-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical