Provider Demographics
NPI:1699028787
Name:OSIFADE, ABISOLA
Entity Type:Individual
Prefix:
First Name:ABISOLA
Middle Name:
Last Name:OSIFADE
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 1:804 LANDMARK DR STE 118
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4486
Mailing Address - Country:US
Mailing Address - Phone:410-863-7213
Mailing Address - Fax:410-863-7205
Practice Address - Street 1:1110 BENFIELD BLVD STE B
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2644
Practice Address - Country:US
Practice Address - Phone:410-863-7213
Practice Address - Fax:410-863-7205
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1699028787OtherNPI