Provider Demographics
NPI:1043897275
Name:ADENEKAN, ADERONKE
Entity Type:Individual
Prefix:
First Name:ADERONKE
Middle Name:
Last Name:ADENEKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADERONKE
Other - Middle Name:ROSEMARY
Other - Last Name:EPHRAIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:127 ALAMERE DR SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3453
Mailing Address - Country:US
Mailing Address - Phone:763-647-0923
Mailing Address - Fax:
Practice Address - Street 1:4450 W EAU GALLIE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7215
Practice Address - Country:US
Practice Address - Phone:321-751-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW171301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical