Provider Demographics
NPI:1801219290
Name:ADEGBENLE, ADEWALE (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:ADEWALE
Middle Name:
Last Name:ADEGBENLE
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3648
Mailing Address - Country:US
Mailing Address - Phone:917-209-6613
Mailing Address - Fax:516-377-0057
Practice Address - Street 1:2620 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3648
Practice Address - Country:US
Practice Address - Phone:917-209-6613
Practice Address - Fax:516-377-0057
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073461104100000X
NY0824171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical