Provider Demographics
NPI:1326749615
Name:OBASAJU, MAYOWA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAYOWA
Middle Name:
Last Name:OBASAJU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:OLUWAMAYOWA
Other - Middle Name:
Other - Last Name:OBASAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:501 W 156TH ST APT 44
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7706
Mailing Address - Country:US
Mailing Address - Phone:516-654-7339
Mailing Address - Fax:
Practice Address - Street 1:501 W 156TH ST APT 44
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7706
Practice Address - Country:US
Practice Address - Phone:516-654-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019045103TC0700X, 103TF0000X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy