Provider Demographics
NPI:1851268445
Name:IDAEWOR, OPEYEMI EMMANUEL (BACHELOR'S DEGREE)
Entity type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:EMMANUEL
Last Name:IDAEWOR
Suffix:
Gender:M
Credentials:BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 FLANDERS ST APT 11
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-1753
Mailing Address - Country:US
Mailing Address - Phone:347-285-5599
Mailing Address - Fax:
Practice Address - Street 1:1356 FLANDERS ST APT 11
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-1753
Practice Address - Country:US
Practice Address - Phone:347-285-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician