Provider Demographics
NPI:1720691777
Name:OLOWE, IFEDOLA 0 (HS-BCP 2303)
Entity Type:Individual
Prefix:
First Name:IFEDOLA
Middle Name:0
Last Name:OLOWE
Suffix:
Gender:F
Credentials:HS-BCP 2303
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 BEACH 46TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1114
Mailing Address - Country:US
Mailing Address - Phone:917-971-1074
Mailing Address - Fax:
Practice Address - Street 1:442 BEACH 46TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1114
Practice Address - Country:US
Practice Address - Phone:917-971-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)