Provider Demographics
NPI:1053465880
Name:OLODE, BUKOLA E (LMSW)
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:E
Last Name:OLODE
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 1:200 BETHEL LOOP APT 11C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1714
Mailing Address - Country:US
Mailing Address - Phone:917-843-4295
Mailing Address - Fax:
Practice Address - Street 1:971 JEROME ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9252
Practice Address - Country:US
Practice Address - Phone:718-272-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720708961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical