Provider Demographics
NPI:1447819354
Name:OGUNFOWORA, KIKELOMO LEANN
Entity type:Individual
Prefix:MS
First Name:KIKELOMO
Middle Name:LEANN
Last Name:OGUNFOWORA
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 1:7 W 30TH ST FL 910
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4406
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:212-967-4919
Practice Address - Street 1:7 W 30TH ST FL 910
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4406
Practice Address - Country:US
Practice Address - Phone:914-703-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical