Provider Demographics
NPI:1083203046
Name:OSAIGBOVO, OTASOWIE LILLIAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:OTASOWIE
Middle Name:LILLIAN
Last Name:OSAIGBOVO
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 1:590 E 169TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2633
Mailing Address - Country:US
Mailing Address - Phone:347-465-2964
Mailing Address - Fax:
Practice Address - Street 1:590 E 169TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2633
Practice Address - Country:US
Practice Address - Phone:347-465-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker