Provider Demographics
NPI:1295130870
Name:OHANENYE, MADU CASIMIR
Entity type:Individual
Prefix:
First Name:MADU
Middle Name:CASIMIR
Last Name:OHANENYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7629 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2703
Mailing Address - Country:US
Mailing Address - Phone:267-471-1997
Mailing Address - Fax:
Practice Address - Street 1:7629 WOODCREST AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2703
Practice Address - Country:US
Practice Address - Phone:267-471-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst