Provider Demographics
NPI:1265860654
Name:SANGOBOWALE, OLUYINKA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:OLUYINKA
Middle Name:
Last Name:SANGOBOWALE
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 1:1900 2ND AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7406
Mailing Address - Country:US
Mailing Address - Phone:212-360-7875
Mailing Address - Fax:212-348-7253
Practice Address - Street 1:1900 SECOND AVENUE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-360-7875
Practice Address - Fax:212-348-7253
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088013-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor