Provider Demographics
NPI:1578003703
Name:BOLADALE, DAMILOLA
Entity Type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:
Last Name:BOLADALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 VAN ARSDALE DR
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4145
Mailing Address - Country:US
Mailing Address - Phone:504-261-7266
Mailing Address - Fax:
Practice Address - Street 1:1125 VAN ARSDALE DR
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08853-4145
Practice Address - Country:US
Practice Address - Phone:504-261-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No253Z00000XAgenciesIn Home Supportive Care