Provider Demographics
NPI:1215678982
Name:FATUNMBI, USHA
Entity type:Individual
Prefix:
First Name:USHA
Middle Name:
Last Name:FATUNMBI
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 1:261 CHAPMAN RD BLDG SUITE102
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5423
Mailing Address - Country:US
Mailing Address - Phone:302-455-9333
Mailing Address - Fax:
Practice Address - Street 1:261 CHAPMAN RD BLDG SUITE102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5423
Practice Address - Country:US
Practice Address - Phone:302-455-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health