Provider Demographics
NPI:1568498848
Name:ONIYIDE, IDOWU OMOSOLA
Entity type:Individual
Prefix:MRS
First Name:IDOWU
Middle Name:OMOSOLA
Last Name:ONIYIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:IDOWU
Other - Middle Name:OMOSOLA
Other - Last Name:AWOITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4 CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7104
Mailing Address - Country:US
Mailing Address - Phone:516-538-5338
Mailing Address - Fax:
Practice Address - Street 1:445 OAK ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3111
Practice Address - Country:US
Practice Address - Phone:631-691-7080
Practice Address - Fax:631-691-3387
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074705-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical