Provider Demographics
NPI:1427340637
Name:KOLAWOLE, OLUBUKONLA (PSYD)
Entity type:Individual
Prefix:DR
First Name:OLUBUKONLA
Middle Name:
Last Name:KOLAWOLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BUKKY
Other - Middle Name:
Other - Last Name:KOLAWOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:105 W 29TH ST APT 29D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5734
Mailing Address - Country:US
Mailing Address - Phone:516-424-5653
Mailing Address - Fax:
Practice Address - Street 1:270 LAFAYETTE ST
Practice Address - Street 2:SUITE 1008
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3311
Practice Address - Country:US
Practice Address - Phone:516-424-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018800103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical