Provider Demographics
NPI:1659663409
Name:OKEKE, GODWIN NNAJI
Entity Type:Individual
Prefix:MR
First Name:GODWIN
Middle Name:NNAJI
Last Name:OKEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GODWIN
Other - Middle Name:NNAJI
Other - Last Name:OKEKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 660920
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-0315
Mailing Address - Country:US
Mailing Address - Phone:718-379-2159
Mailing Address - Fax:212-423-7804
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-7016
Practice Address - Fax:212-423-7804
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051166-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker