Provider Demographics
NPI:1619147980
Name:ODUYEMI, IBILOLA (CAS, MS)
Entity Type:Individual
Prefix:MS
First Name:IBILOLA
Middle Name:
Last Name:ODUYEMI
Suffix:
Gender:F
Credentials:CAS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-21 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-3968
Mailing Address - Country:US
Mailing Address - Phone:518-725-4310
Mailing Address - Fax:518-725-2556
Practice Address - Street 1:11-21 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-3968
Practice Address - Country:US
Practice Address - Phone:518-725-4310
Practice Address - Fax:518-725-2556
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health