Provider Demographics
NPI:1265039358
Name:OKENWA, MARIAH (MA)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:
Last Name:OKENWA
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 ELMWOOD AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2202
Mailing Address - Country:US
Mailing Address - Phone:716-336-0653
Mailing Address - Fax:
Practice Address - Street 1:266 ELMWOOD AVE STE 260
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2202
Practice Address - Country:US
Practice Address - Phone:716-336-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002171-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist