Provider Demographics
NPI:1861375602
Name:DADA, ADEKUNLE MICHAEL (CASAC-T)
Entity type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:MICHAEL
Last Name:DADA
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2312
Mailing Address - Country:US
Mailing Address - Phone:347-755-6319
Mailing Address - Fax:
Practice Address - Street 1:1268 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2312
Practice Address - Country:US
Practice Address - Phone:347-755-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)