Provider Demographics
NPI:1659998045
Name:AKEREDOLU, LATEEF (CASAC-T)
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:AKEREDOLU
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ARCADIA PL APT 1C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2273
Mailing Address - Country:US
Mailing Address - Phone:917-756-7621
Mailing Address - Fax:
Practice Address - Street 1:1268 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2312
Practice Address - Country:US
Practice Address - Phone:718-981-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)