Provider Demographics
NPI:1538414180
Name:ABIONA, YEMISI TEMITOPE (MSW)
Entity type:Individual
Prefix:
First Name:YEMISI
Middle Name:TEMITOPE
Last Name:ABIONA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2532
Mailing Address - Country:US
Mailing Address - Phone:973-722-2809
Mailing Address - Fax:
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2532
Practice Address - Country:US
Practice Address - Phone:973-722-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054677001041C0700X
NM37LC00244000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)