Provider Demographics
NPI:1568270064
Name:ADEMUWAGUN, DOLAPO A
Entity type:Individual
Prefix:
First Name:DOLAPO
Middle Name:A
Last Name:ADEMUWAGUN
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 1:292 EDMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3512
Mailing Address - Country:US
Mailing Address - Phone:267-945-9067
Mailing Address - Fax:
Practice Address - Street 1:292 EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3512
Practice Address - Country:US
Practice Address - Phone:267-945-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006077103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst