Provider Demographics
NPI:1558959924
Name:ELESHO, MUYIWA ARIKE (LCSW)
Entity Type:Individual
Prefix:
First Name:MUYIWA
Middle Name:ARIKE
Last Name:ELESHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MUYIWA
Other - Middle Name:ARIKE
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MUYIWA ARIKE RAHMAN
Mailing Address - Street 1:4432 BLUE HERON WAY
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1899
Mailing Address - Country:US
Mailing Address - Phone:347-446-8629
Mailing Address - Fax:
Practice Address - Street 1:4432 BLUE HERON WAY
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1899
Practice Address - Country:US
Practice Address - Phone:347-446-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040124861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical