Provider Demographics
NPI:1073891263
Name:BADMUS, GANIYAT HALLE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:GANIYAT
Middle Name:HALLE
Last Name:BADMUS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:GANIYAT
Other - Middle Name:OLABISI
Other - Last Name:MAKANJUOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11779 SOMERSET AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1271
Mailing Address - Country:US
Mailing Address - Phone:443-754-2164
Mailing Address - Fax:866-993-1076
Practice Address - Street 1:11779 SOMERSET AVE STE 12
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1271
Practice Address - Country:US
Practice Address - Phone:443-754-2164
Practice Address - Fax:866-993-1076
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD119591300Medicaid
MD211811Medicare Oscar/Certification