Provider Demographics
NPI:1457107559
Name:EBESUNUN, NNEKA (LMSW)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:EBESUNUN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ROCKAWAY AVE APT 22K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4247
Mailing Address - Country:US
Mailing Address - Phone:347-596-3978
Mailing Address - Fax:
Practice Address - Street 1:7801 BROADWAY # A1-25
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-2650
Practice Address - Fax:718-334-1411
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121897104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker