Provider Demographics
NPI:1194687376
Name:ADEBANJO, OMOLARA
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:ADEBANJO
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 1:524 N REESER DR
Mailing Address - Street 2:
Mailing Address - City:YORK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17370-9618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7720 LINCOLN HWY E
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2773
Practice Address - Country:US
Practice Address - Phone:412-440-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty