Provider Demographics
NPI:1912213018
Name:ODEGBAMI, DANIEL GBOLAHAN (MSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GBOLAHAN
Last Name:ODEGBAMI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 8TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2119
Mailing Address - Country:US
Mailing Address - Phone:510-688-8467
Mailing Address - Fax:
Practice Address - Street 1:555 MOWRY AVE STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4101
Practice Address - Country:US
Practice Address - Phone:510-657-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool