Provider Demographics
NPI:1699448415
Name:OMOLAYO, VICTORIA (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:OMOLAYO
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 1:94 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8365
Mailing Address - Country:US
Mailing Address - Phone:631-252-2820
Mailing Address - Fax:
Practice Address - Street 1:94 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8365
Practice Address - Country:US
Practice Address - Phone:631-252-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker