Provider Demographics
NPI:1912414558
Name:IBISANMI RELATIONAL HEALTH MARRIAGE AND FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:IBISANMI RELATIONAL HEALTH MARRIAGE AND FAMILY THERAPY, PLLC
Other - Org Name:IBISANMI RELATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:AWOSAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:315-491-8722
Mailing Address - Street 1:311A W 50TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:917-310-2662
Mailing Address - Fax:
Practice Address - Street 1:311A WEST 50TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:315-491-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001353-1106H00000X
NJ37FI00180900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty