Provider Demographics
NPI:1861041626
Name:ROSHELLE OGUNDELE LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:ROSHELLE OGUNDELE LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-647-1370
Mailing Address - Street 1:3727 VIRDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1536
Mailing Address - Country:US
Mailing Address - Phone:516-647-1370
Mailing Address - Fax:
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:510-560-6271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)