Provider Demographics
NPI:1447674239
Name:OLATUNDE, ISAAC OLADIRAN
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:OLADIRAN
Last Name:OLATUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RUSSELL CONWELL CT APT 309
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2343
Mailing Address - Country:US
Mailing Address - Phone:978-968-0596
Mailing Address - Fax:
Practice Address - Street 1:243 WESTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3026
Practice Address - Country:US
Practice Address - Phone:781-780-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health