Provider Demographics
NPI:1194433656
Name:NWAGBOLI, BRITTANEY CHIOMA
Entity type:Individual
Prefix:
First Name:BRITTANEY
Middle Name:CHIOMA
Last Name:NWAGBOLI
Suffix:
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 1:355 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3523
Mailing Address - Country:US
Mailing Address - Phone:203-430-8566
Mailing Address - Fax:
Practice Address - Street 1:355 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3523
Practice Address - Country:US
Practice Address - Phone:203-430-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical