Provider Demographics
NPI:1043765571
Name:AKINTIDE, WUMI (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WUMI
Middle Name:
Last Name:AKINTIDE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NEILSON ST
Mailing Address - Street 2:APT 6P
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5047
Mailing Address - Country:US
Mailing Address - Phone:347-453-0990
Mailing Address - Fax:
Practice Address - Street 1:1040 NEILSON ST
Practice Address - Street 2:APT 6P
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5047
Practice Address - Country:US
Practice Address - Phone:347-453-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056063-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker