Provider Demographics
NPI:1710204193
Name:OMIUNU, JULIUS (MASTERS)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:OMIUNU
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2431
Mailing Address - Country:US
Mailing Address - Phone:401-231-7760
Mailing Address - Fax:401-722-5039
Practice Address - Street 1:25 CEDAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2431
Practice Address - Country:US
Practice Address - Phone:401-231-7760
Practice Address - Fax:401-722-5039
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid