Provider Demographics
NPI:1194231050
Name:OGUNMOLA, OLUWOLE EMMANUEL
Entity type:Individual
Prefix:MR
First Name:OLUWOLE
Middle Name:EMMANUEL
Last Name:OGUNMOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 17TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1281
Mailing Address - Country:US
Mailing Address - Phone:718-233-2533
Mailing Address - Fax:
Practice Address - Street 1:1670 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1281
Practice Address - Country:US
Practice Address - Phone:718-233-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health