Provider Demographics
NPI:1114453560
Name:AJIBOYE, ALICIA (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:AJIBOYE
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 BUTTERWICK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1051
Mailing Address - Country:US
Mailing Address - Phone:513-349-5533
Mailing Address - Fax:
Practice Address - Street 1:8904 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3139
Practice Address - Country:US
Practice Address - Phone:513-644-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1450657SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical