Provider Demographics
NPI:1194223669
Name:AKINBOLA, PAUL DABIRA
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DABIRA
Last Name:AKINBOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4318
Mailing Address - Country:US
Mailing Address - Phone:516-567-7466
Mailing Address - Fax:
Practice Address - Street 1:1817 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4318
Practice Address - Country:US
Practice Address - Phone:516-567-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health