Provider Demographics
NPI:1952775611
Name:ADEGOKE, BOLANLE KUDIRATU (PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:BOLANLE
Middle Name:KUDIRATU
Last Name:ADEGOKE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 THOMAS S BOYLAND ST
Mailing Address - Street 2:APT 23C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4156
Mailing Address - Country:US
Mailing Address - Phone:718-415-3645
Mailing Address - Fax:
Practice Address - Street 1:493 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5117
Practice Address - Country:US
Practice Address - Phone:718-230-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701175-1163W00000X
NYF4037462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No163W00000XNursing Service ProvidersRegistered Nurse