Provider Demographics
NPI:1700469186
Name:BANJO, TOLUWALOPE ABIOLA
Entity Type:Individual
Prefix:
First Name:TOLUWALOPE
Middle Name:ABIOLA
Last Name:BANJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MSGR LYDON WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3082
Mailing Address - Country:US
Mailing Address - Phone:781-526-4247
Mailing Address - Fax:
Practice Address - Street 1:25 MSGR LYDON WAY APT 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3082
Practice Address - Country:US
Practice Address - Phone:781-526-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician