Provider Demographics
NPI:1679807234
Name:OGBONNA, OLIVER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BENJAMIN LN
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6742
Mailing Address - Country:US
Mailing Address - Phone:917-701-4329
Mailing Address - Fax:718-588-5704
Practice Address - Street 1:8 BENJAMIN LANE
Practice Address - Street 2:
Practice Address - City:CORDTLAND MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:917-701-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519121104100000X
NY0751411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker