Provider Demographics
NPI:1083279343
Name:KUFORIJI, MATANMI OLUSESAN (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:MATANMI
Middle Name:OLUSESAN
Last Name:KUFORIJI
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 CORN STREAM ROAD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:410-493-2975
Mailing Address - Fax:410-233-1991
Practice Address - Street 1:2300 GARRISON BOULEVARD SUITE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216
Practice Address - Country:US
Practice Address - Phone:410-233-1990
Practice Address - Fax:410-233-1991
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical