Provider Demographics
NPI:1871067892
Name:OLUDARE, OLUREMI EMMANUEL
Entity type:Individual
Prefix:
First Name:OLUREMI
Middle Name:EMMANUEL
Last Name:OLUDARE
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 1:1201 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2042
Mailing Address - Country:US
Mailing Address - Phone:302-798-7033
Mailing Address - Fax:302-798-7216
Practice Address - Street 1:1201 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2042
Practice Address - Country:US
Practice Address - Phone:302-798-7033
Practice Address - Fax:302-798-7033
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE832532346Medicaid