Provider Demographics
NPI:1740097922
Name:ODOOM, EMMANUELLA EWUSIWAA
Entity type:Individual
Prefix:MISS
First Name:EMMANUELLA
Middle Name:EWUSIWAA
Last Name:ODOOM
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 1:1856 LAFAYETTE AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2842
Mailing Address - Country:US
Mailing Address - Phone:347-833-6458
Mailing Address - Fax:
Practice Address - Street 1:1856 LAFAYETTE AVE APT 4E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2842
Practice Address - Country:US
Practice Address - Phone:347-833-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician